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An analysis of numerous studies has shown that the most frequently prescribed diabetic drug, metformin, reduces a patients mortality risk due to heart disease by 30-40% as compared to its closest competitor drug, the sulphonylureas.
Diabetes has been diagnosed in over 400 million people worldwide and this number is thought to be nearly doubled due to undiagnosed patients. Diet and exercise have been shown to work in controlling glucose levels to the point where patients are cured, but most patients will eventually need medication.

Diabetes can lead to fatal complications if not properly controlled. The most common issues tends to be involved with cardiovascular conditions which include heart attacks and strokes. Other complications of diabetes can also include kidney failure, blindness and amputation of limbs.

An analysis of 204 studies was recently published where the researchers looked at which diabetic medications aided in lowering the risk of developing cardiovascular complications due to diabetes, and whether one type of medication was better than another in this function. 

The study

Many new diabetic drugs have been introduced in the market over the last few years, therefore it was important to conduct this review since it would provide an update on previous studies that were done comparing diabetic drugs.

The participants in the studies were from all over the world and they were generally overweight people who had uncontrolled glucose levels. The elderly and people with significant health issues were excluded from the studies. 

Factors that were examined in these studies included not only cardiovascular disease, but also other medication effects such as glucose control and side-effects such as weight gain, gastrointestinal problems and lowered glucose levels. The researchers also reported on how the diabetic drugs worked on their own, as monotherapy, and in combination. Injectable insulin was only compared if it was used as combination therapy with other oral drugs.

The findings of the review were as follows:

  • The DPP-4 inhibitors, which were introduced around 2011, were found to be less effective in lowering blood glucose levels as compared to the older drugs metformin and the sulphonylureas.
  • A very new class of diabetic medications known as the SGLT-2 inhibitors, which cause glucose to be removed from the blood via the kidneys, were found to increase the incidence of yeast infections in 10% of patients using this drug. 
  • SGLT-2 inhibitors and the GLP-1 receptor agonists helped patients to lose weight, whereas the sulphonylureas caused weight gain and were the biggest culprits in causing lowered glucose levels in patients.
In the end, it was noted that metformin performed better than the other older and newer drugs that are available to manage diabetes regarding side-effect profile, medicine effect and in lowering the rate of complications. These findings are said to be in line with current management recommendations that metformin be initiated as first-line therapy in the treatment of type 2 diabetes. The other mentioned medications would then be used in combination with metformin, as second-line therapies, depending on the patient's unique circumstances and preferences. 

The significance of this review 

The above-mentioned findings have shown that metformin should still be used as first-line therapy in the treatment of diabetes. This helps public health agencies to continue with their current management protocols. It will also lower the financial burden on these agencies and the patients since metformin is still a relatively inexpensive medication.

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