New Type 2 Diabetes Drug Delays Disease Progression

Avandia delayed the need for additional drugs by 60 months, compared with 45 months for Glucophage and 33 months for Micronase.

Participants taking Avandia had more weight gain and edema while participants on Micronase had a lower risk of cardiovascular events. One unexpected finding was that women taking Avandia had more fractures, primarily in the hands and feet.

A surprisingly high proportion of participants dropped out of the study, the editorial pointed out.

And not only did Avandia have cardiovascular effects, it did so even though patients in this group were taking more of the cholesterol-lowering drugs known as statins because the drug appeared to raise their LDL ("bad") cholesterol, Nissen said.

Avandia seems clearly superior to Micronase, but the distinction between Avandia and Glucophage is less clear.

"In my opinion, the use of [Micronase] for any reason other than cost is going to become harder to justify," said Kahn, associate chief of staff for research at Veterans Affairs Puget Sound Health Care System and professor of medicine at the University of Washington, Seattle. "On the other hand, when you compare [Glucophage] and [Avandia], this is where it starts to become a little grayer... A lot more has to be done in terms of human investigation."

Overall, it's still not clear how physicians should treat patients.

"We're being inundated by medications, and we're being overwhelmed by patients who are not controlled by either one or even two medications. So, we're really talking about a condition that's going to be treated with multiple medications," said Dr. Stuart Weiss, clinical assistant professor of medicine at New York University School of Medicine. "The only thing that we can say is that combination therapy might be the best way to go from the beginning, and this study doesn't even address that."

More information

For more about type 2 diabetes, visit the National Diabetes Information Clearinghouse.

SOURCES: Steven E. Kahn, M.B., C.B., associate chief of staff, research, Veterans Affairs Puget Sound Health Care System, and professor, medicine, University of Washington, Seattle; Robert Rizza, M.D., past president, American Diabetes Association, and professor, medicine, Mayo Clinic College of Medicine, Rochester, Minn.; Steven E. Nissen, M.D., chairman, department of cardiovascular medicine, Cleveland Clinic, and president-elect, American College of Cardiology; Stuart Weiss, M.D., endocrinologist, New York University Medical Center and clinical assistant professor, NYU School of Medicine, New York City; Dec. 7, 2006,New England Journal of Medicine