November 15, 2012

Metformin Safer for Type 2 Diabetes Outcome


The current issue of Annals of Internal Medicine published a study that shows the use of sulfonylureas compared with metformin for the treatment of diabetes was associated with an increased hazard of CVD events or death.

Diabetes increases risk for cardiovascular disease, but how metformin and sulfonylureas affect that risk is less clear. The study compared the outcomes of patients treated with either a metformin drug or a sulfonylureas drug.

Sulfonylureas are the oldest class of medications other than insulin used for diabetes treatment. Some of the brand names for sulfonylureas are: Amaryl, Glucotrol, Glucotrol XL, DiaBeta, Glynase, PresTab, and Micronase.  Sulfonylureas stimulate the beta cells of the pancreas to release more insulin.

Sulfonylureas can induce weight gain, mainly as a result of their effect to increase insulin levels and the utilization of glucose and other metabolic fuels. Other side-effects are abdominal upset and headache.

Metformin drugs are  the first choice of many doctors for the treatment of type 2 diabetes in overweight and obese people. The brand names of metformin drugs are: Glucophage, Glumetza, Fortamet, and Glucophage XR. Metformin drugs work by reducing the amount of sugar made by the liver, limits the amount of sugar absorbed into the body from the diet, and makes insulin receptors more sensitive.

The most common side effect for metformin drugs is gastrointestinal upset, including diarrhea, cramps, nausea, vomiting and increased flatulence.

Metformin is recommended as a choice therapy for patients who do not have kidney disease and other conditions involving lactic acidosis. Sulfonylureas are sometimes preferred because they require little titration and have fewer gastrointestinal adverse effects than metformin. Compared with metformin, sulfonylureas are associated with increases in weight and lipid levels and greater risk for hypoglycemia. The final results of this study found in-favor of metformin.

It is unclear whether sulfonylureas are harmful or metformin is protective. If you err with caution – stick with metformin. If you can’t be bothered with the potential tummy troubles and titrating – go for broke with sulfonylureas, but you’ve been warned. Spice it up a little on your next doctor’s visit. Print out the study and engage your physician in a diabetes treatment option debate. He or she may be impressed (or thoroughly annoyed).

Visit Your Diabetes Health for more resources about health.