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Side Effects May Sway Drug Choices for Tough-to-Manage Diabetes
Date:5/19/2011

By Serena Gordon
HealthDay Reporter

THURSDAY, May 19 (HealthDay News) -- When someone with type 2 diabetes needs a third medication to control blood sugar levels, the choice may come down to which drug has the least undesirable side effects, because the available medications all lower blood sugar in a similar manner.

That's the conclusion of a new review of data that shows there were no great differences in the ability of various classes of medication to lower blood sugar among type 2 diabetics, when used as "third-line" treatment (after a first and second drug don't suffice).

However, the study also found that some medications could cause weight gain, and some caused episodes of low blood sugar levels (hypoglycemia).

In any event, "type 2 diabetes is a progressive disease and most patients will need the combination of two or three anti-hyperglycemic agents to reach good glucose control in the long-term," noted the study's lead author, Dr. Jorge Gross, a professor of medicine at the Hospital de Clinicas de Porto Alegre, Brazil.

"The choice of the third agent should be individualized according to the characteristics of the patients and the undesirable effects of the medications, so you can't elect one agent to be used in all patients with type 2 diabetes," he explained.

The study results were published in this week's issue of the Annals of Internal Medicine.

Metformin, an older medication that's available as a generic, is generally recommended as a first-line treatment for type 2 diabetes, along with physical activity and diet changes. If metformin and lifestyle changes fail to control blood sugar well, a second drug is generally added.

For this study, the researchers chose the commonly used combination of metformin and a sulfonylurea. Drugs in the sulfonylurea class are usually available as generics and include: glyburide, glipizide, chlorpropamide, tolbutamide and tolazami
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