Thursday, May 10, 2012
What are the best and safest pills for diabetes?
There is really no best or safest pill for treatment of diabetes, because certain pills (usually called oral antidiabetic drugs or OADs) are appropriate for certain patients but not for others. Therefore, it is important for the prescribing physician to take a number of fac- tors pertaining to the patient into account before rec- ommending a specific OAD or combination of OADs. Although therapy must be individually selected for each patient, certain general statements can be made. The newer OADs sitagliptin and saxagliptin, which belong to a class of OADs known as DPP-IV inhibitors, appear to be especially safe, in that sitagliptin does not interact with other drugs (although saxagliptin alters plasma levels of some drugs and needs to be either not used or used with caution when taking these) and do not appear to have any serious side effects. Although a few patients may have experienced serious allergic reac- tions with sitagliptin, this is a very tiny minority of the many patients who have taken the drug. Which OAD could be considered the best (in the sense of most effective) is quite debatable, because several types of OAD have similar effectiveness and this varies accord- ing to the timing of their use in the course of the dia- betes. One must also consider the fact that some OADs tend to fail after a certain time of use, while others have less of a tendency to do so. In addition, some OADs, such as pioglitazone, have other benefits in addition to their effect on blood sugar, such as improving the cholesterol level and lowering blood pressure and per- haps even lowering the rate of heart attacks. Taken together, all this indicates that there is no single best drug for all patients with diabetes, but that for each patient there is one or more OADs that are safest and most effective for him or her.