Treatment

Good Drugs, Bad Drugs

David Mendosa Health Guide December 13, 2009
  • We know that the only person who can tell us what to eat and exercise is ourself. But most of us need a third leg of diabetes control -- one or more of the prescription drugs -- and we usually leave that decision up to our doctor.

    Often this is a big mistake. Many of our doctors are too set in their ways. The problem is simply that doctors too are human.

    Older doctors have practiced most of their lives with a Hobson's choice of one oral diabetes drug. In 1957 the first sulfonylureas became available by prescription in the United States. Not until about 40 years later did the Food and Drug Administration approve a second diabetes drug, metformin.


    Until we could get metformin, we did have the opportunity to take insulin instead of a sulfonylurea. And we had a lot of different sulfonylureas to choose from, making it appear that our choice was greater that it really was. Brand names include Amaryl, Glucotrol XL, Diaßeta, Glynase, Micronase, as well as Dymelor, Diabinese, Orinase, and Tolinase. Combination drugs like Metaglip, Glucovance, Avandaryl, and Duetact also are part sulfonylurea.

    All of these sulfonylureas help the body release more insulin. That's their strength and at the same time their weakness. They work constantly. Therefore, some people are concerned that taking them will eventually burn out the beta cells of the pancreas.

    I don't think that we have any proof one way or the other whether years of taking a sulfonylurea will lead to beta cell burnout.

    But we know for sure that taking too much of any of the sulfonylureas can lead to a hypoglycemic episode where our blood glucose goes dangerously low. This is what we all too familiarly call a hypo.

    That's not all. People who take a sulfonylurea typically gain weight. This is of course something that we few of us need and which makes it even harder for us to control our diabetes.

    Now, a study released just this month in the leading British medical journal has linked sulfonylureas to an increase risk for heart failure and death compared with metformin.

    The BMJ, formerly known as the British Medical Journal, published this shocking study December 3 as "Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs." The full text of this important article is online.

    The article reported on a big study. It included 91,251 men and women that they followed for more than seven years. In that time the study participants suffered 3,588 cases of myocardial infarction, 6,900 of congestive heart failure, and 18,548 deaths. The people in the study who were taking a sulfonylurea and no other diabetes drug had a statistically significantly greater risk of congestive heart failure and of death from all causes.

    As big a study as it was, this was a retrospective cohort study. This type of study shows correlations. While a correlation isn't proof, it warrants our careful consideration.

    If your doctor is British, he or she will almost certainly know about this study. However, don't count on an American doctor to be familiar with it. Besides, we are bombarded every day with new medical information that we expect our doctors to read in their so-called spare time. Beyond that, sometimes changing your prescription can be just too much trouble for a busy doctor.


  • So, the ball is in your court. Discuss your medication with your doctor. Remember that you have the primary responsibility for controlling everything about your diabetes.