THURSDAY, May 19- when a person with diabetes type 2 a need for a third drug of glycemic control, the choice may come to the drug has adverse effects, because the available drugs lower blood sugar in a similar way.
This is the conclusion of a new review data show that were there no large differences in the ability of the various classes of sugar drugs lower blood among the type 2 diabetics, when used as a "third party" treatment online (after a first and second drug is enough).
However, the study also found that some drugs may cause weight gain, and some episodes of low blood sugar (hypoglycemia).
In any event, "the type 2 diabetes is a progressive disease and most patients will need the combination of two or three hypoglycemic agents to achieve good glycemic control in the long term", noted author studyDr. Jorge gross, a Professor of medicine at Hospital de Clinicas Porto AlegreBrésil.
He explained: "selection of the third officer should be individualized according to the characteristics of the patients and the adverse effects of drugs, so you cannot elect an agent to be used in all patients with diabetes type 2"., ?.
The results of the study were published in this week of Annals of Internal Medicine.
Metformin, an older drug that is available as a generic, is generally recommended as a first line treatment for type 2 diabetes, with physical activity and diet changes. If metformin and lifestyle changes fail to control blood sugar well, a second drug is usually added.
For this study, researchers selected the commonly used combination of metformin and a sulfonylurea. Are usually available as generics and include drug of the sulfonylurea class: glyburide, glipizide, chlorpropamide, tolbutamide, and tolazamide.
"This study focused on what is probably the most common combination of drugs for diabetes, but even the second line therapy should be individualized based on the needs of the patient, said Dr. Robert Henry, Chairman of medicine and the sciences of the American Diabetes Association.".
Included alpha-glucosidase (acarbose) inhibitors, thiazolidinediones (which include Avandia and Actos), are investigating third-line drugs in the current of glucagon-like peptide-1 (GLP - 1) agonists and dipeptidyl peptidase-4 inhibitors (DPP-4).
The review included 18 clinical trials with a total of more than 4,500 people. Studies last for an average of more than 31 weeks.
When the researchers compared the reductions in rates of Hemoglobin A1C (HbA1C), they have not found any statistically significant difference between the third-line drugs. A1C is a blood test that measures long term (approximately two to three months) of blood glucose levels.
Weight gain was more frequent among people taking insulin or a thiazolidinedione. For those on insulin mean weight gain was approximately six books, according to the study. Those of the thiazolidinediones, mean weight gain was more than nine books.
3.6 Pounds in weight loss was observed in people taking GLP-1 agonists, reported in the study. Insulin is most likely to reduce blood glucose levels too, increase the chances of hypoglycemia, according to the study.
Dr. Joel Zonszein, Director of the Centre of clinical diabetes Montefiore Medical Center in New York City, noted that "they are mainly company drug studies and are not long term studies."
This review "shows that giving a third agent can help, and it also shows us that these drugs have effects of good and bad," said. "But we really need long term studies on the combinations that are not sponsored by pharmaceutical companies."
The bottom line, according to Zonszein: "each patient must be treated individually." They are obese? If Yes, there are certain drugs such as insulin and thiazolidinediones may cause weight gain, that we do not want. ?
When it comes to agents of the third line, said Henry, another factor may be price. Some drugs are not always available in generic form, making them much more expensive.
If you have specific concerns, such as weight gain or a price, said Henry it is important to bring these concerns to the attention of your doctor when you're talking about adding another medication for diabetes.
"If a third drug is necessary because blood sugar control is not appropriate, obtain a tailored to your specific needs," he advised.
"We believe that the results of this study offer a wide range of choice of hypoglycemic agents that could be used as the third option in patients of diabetes type 2 not controlled with metformin and sulfonylurea based on efficiency." "The final decision depends on the effects in the weight and risk of hypoglycemia," said Gross.
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