No particular medicine to treat type 2 diabetes surpasses others regarding the reduction of heart disease, stroke (stroke) or premature death, finds a new research review.

The analysis of hundreds of clinical trials did not find evidence that any medication for diabetes in particular, or combination of medicines, exceeds others.

The researchers said the results support the current recommendations to prove first with the oldest and most cheaper drug, metformin (glumetza, glycophage), in most patients with type 2 diabetes.

"There are very few things that experts agree, but this is one of them," said Dr. Kevin Pants, a diabetes specialist at the Cleveland Clinic and member of the endocrine society (Endocrine Society).

"Metformin, if there are no contraindications or intolerability, should be the frontline agent to treat patients with type 2 diabetes," he said.

Metformin can cause stomach and diarrhea discomfort, so that some patients cannot take it daily, explained Pants, who did not participate in the study.And people with renal disease in general should not take it, he said.

More than 29 million Americans have diabetes, the majority of type 2, according to the Centers for the control and prevention of diseases (CDC) of the US.

The disease, which is often linked to obesity, makes blood sugar levels chronically high.Over time, that can lead to complications, such as heart disease, stroke, renal failure and nervous damage, warn CDC.

There are many kinds of medications that reduce blood sugar levels.

What was not clear was if any of these medications worked better than others to avoid diabetes complications and extend people's lives.

The new analysis did not find any obvious winner.

But the researchers also warned that no conclusion should be extracted: the review tests were not specifically designed to see if any of the medications extended life.

Mainly they observed the "biochemical" effects, for example if drugs reduced blood sugar, Suetonia Palmer, a leading work researcher, explained.

"What we know is that there is currently no firm evidence that a medicine can improve life expectancy more than another, used as the only drug treatment or added to metformin," said Palmer, associate professor of the Department of Medicine of the Medicine of the Medicine ofUniversity of Otago, in New Zealand.

In the study, the Palmer team gathered the results of 301 clinical trials that evaluated 9 classes of diabetes medications.

Drugs included ancient pillars such as metformin, insulin and sulfonylureas such as glipizide (glucotrol) and glymepirid (amaryryl).Other essays observed newer and more expensive classes, including thiazolidiniones such as Pioglitazone (acts) and Rosiglitazone (Avandia), and DPP inhibitors such as Sitagliptin (Januvia) and Saxagliptin (Onglyza).

Many essays only evaluated a single drug, but more than 100 studies used a medication in combination with metformin.

In general, metformin equal function of good or better than other medications to reduce blood sugar levels, found the review.

10 health differences between men and women

Regarding the prevention of complications or prolongation of life, no medicine or combination of medications in particular stood out.

But according to Palmer, the problem was the lack of evidence, which is not the same as prove that all medications are the same, he said.

Pants seHe showed."This [analysis] included many short -term studies," he said, and noted that some only lasted 6 months.

"I think the important finding is that there was no sign that a therapy could be more harmful than another from the cardiovascular point of view," said Pants.

That is important, he explained, because the Food and Medicines Administration (FDA) of the US has only demanded that diabetes medications go through a cardiovascular safety evaluation since 2008. Then, the oldest medications never passed through thatprocess.

In addition, he commented Pants, there is evidence of recent trials that two newer diabetes medications can, in fact, control the risk of death due to cardiovascular disease or stroke.These medications are an injectable drug called Liraglutida (Victaza) and an oral drug called Pagliflozina (Jardiance).

But metformin remains the recommended frontline drug.Pants pointed out that not only reduces blood sugar, but also entails a low risk of hypoglycemia, which is a potentially dangerous downturn of blood sugar.

If another drug should be added, the decision must be based on the general health of a person and the side effects of the different medications, said Pants.

Some medications, such as insulin and sulfonylureas, are more likely to cause hypoglycemia, for example.Others can cause weight gain, said Pants.

He emphasized that regardless of the drug used, changes in the lifestyle of people with type 2 diabetes remain key.

"The modification of lifestyle, through changes in diet and regular exercise, is an essential component of any treatment regime," Pants emphasized.

The study appears in the July 19 edition of the Journal of the American Medical Association.

More information

The American Diabetes Association (American Diabetes Association) offers more information about type 2 diabetes medications.

Article by Healthday