All drugs have side effects, some worse than others. Yet one of the cornerstones of diabetes management along with diet, weight control, and exercise, is to take insulin or one of the many diabetes medications that our doctors routinely prescribe.
People with type 1 diabetes have no choice. They have to take insulin. But the great majority of us have type 2 and mostly take one or two or even three different pills for our condition.
Some of these pills are clearly safer than others. For example, none of us take Rezulin any more, now that it killed at least 63 people. That was a dozen years ago so I wouldn't be surprised if you forgot about Rezulin or never heard of it, but half a million of us were using it when the U.S. Food and Drug Administration recalled it.
Six years later Avandia became even bigger than Rezulin, earning GlaxoSmithKline $2.5 billion that year. Not so many of us take Avandia now that studies show that it raises the risk of heart attack by 43 percent.
Recently, yet another diabetes drug, Actos, seems to be life-threatening. Already banned in parts of Europe because it may cause bladder cancer, the FDA says that doctors should be cautious when telling us to take Actos. "The benefits of blood sugar control with pioglitazone," it says, "should be weighed against the unknown risks for cancer recurrence."
Even the diabetes drug that the most people with type 2 diabetes use can't be completely safe. Metformin carries what the FDA calls a "black box warning." Named for the black box that usually surrounds the warning, it means that the drug may cause serious adverse effects. Metformin's black box warning says that lactic acidosis is a rare result of taking metformin, but when it happens it can lead to death half of the time.
I took my chances with metformin until February 2006. That's when I took an even bigger chance.
In 2005 I had written here about the "Worst Diabetes Pills," citing the sensible advice of Public Citizen's Health Research Group not to use most pills until seven years after they came on the market. The only exception they made was for breakthrough drugs that were much better than anything else.
When I stopped metformin to take a chance on Byetta, I was gambling on a drug that had come on the market less than a year earlier. Even now the Health Research Group's cautious waiting period is not quite over.
I had assumed that Byetta was indeed a breakthrough drug. Our subsequent experience with it seems to bear out this assumption. But some researchers are concerned that the GLP-1 medications, including Byetta and Victoza, might cause pancreatitis and pancreatic cancer.
I seem to have lucked out with Byetta. But I'm not much of a gambler with my money, much less with my health.
When a good friend of mine who is also a wise Certified Diabetes Educator encouraged me to manage my diabetes without drugs, I accepted the challenge. In December 2007 I stopped taking any diabetes drugs.
Since that time I have been able to control both my blood glucose level and my weight. I did it by chosing the only alternative that I knew at that time, following a very low-carbohydrate diet. It's still the only way that I know to manage diabetes without drugs.
In the past four or five years I've written again and again about new studies showing the benefits of a low-carb lifestyle. But now I can report a new study on the flip side of the coin.
A study that the BMJ (formerly the British Medical Journal) published recently shows just how dangerous the side effects of diabetes drugs are. The study is a meta-analysis, one that combines the results of several studies to more powerfully estimate the real effect of something. In this case that something is the diabetes drugs that most of us take.
The BMJ editors thought that the article is so important that they made the full-text free online. You may want to read through its dense, scientific language for yourself. Here is a taste from the concluding paragraph: "The overall results of this meta-analysis do not show a benefit of intensive glucose lowering treatment on all cause mortality or cardiovascular death. A 19% increase in all cause mortality and a 43% increase in cardiovascular mortality cannot be excluded."
Note that the meta-analysis reviewed studies of intensive glucose-lowering treatments. Still, as the authors point out, "It is paradoxical to propose intensive glucose lowering treatment when available drugs have no proved intrinsic efficacy."
Does this mean you should throw away your pills? I would never give that advice. Instead, I urge as many of us as possible to use the safest diabetes drugs that we can and only as a temporary measure. When you and your doctor agree that you are managing your diabetes well enough with your diabetes drugs, you can then become drug-free with the only alternative that works.