Background

If you have type 2 diabetes, your doctor will consider prescribing medication to keep your blood sugar levels in a normal range. To help you and your doctor choose a diabetes medicine, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost.

This brief is a summary of a 29-page report you can access at CRBestBuyDrugs.org. Our evaluation of diabetes drugs is based largely on a thorough, independent review of the scientific research on diabetes drugs. One hundred and sixty-six studies were closely examined out of thousands screened. The review was conducted in 2010 by a team of physician researchers at the Johns Hopkins University Evidence-based Practice Center. This team conducted the review as part of the Effective Health Care Program sponsored by the Agency for Healthcare Research and Quality, a federal agency. The full report is available at www.effectivehealthcare.ahrq.gov/reports/final.cfm. Additional sources were used to update this review, as well as an analysis of selected classes of diabetes drugs conducted by the Drug Effectiveness Review Project (DERP) based at Oregon Health & Science University. The full DERP report is available at www.ohsu.edu/xd/research/centers-institutes/evidence-based-policy-center/derp/index.cfm.

Neither the Johns Hopkins University Evidence-based Practice Center, the Agency for Healthcare Research and Quality, nor DERP is in any way responsible for the advice and recommendations in this report. These entities also played no role in selecting our Best Buy drugs; Consumer Reports Best Buy Drugs is solely responsible for those.

These materials are made possible by the states Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.

This report was updated in December 2012.

Do You Need a Diabetes Drug?

Evidence strongly supports the additive effect of lifestyle changes plus medicines. But several studies also show that many people with diabetes can lower their blood sugar levels almost as much with lifestyle changes alone as with medicines, especially in the early stages of their disease.

Thus, given that (a) all the diabetes drugs have the potential to cause side effects and (b) lifestyle changes have benefits to your health beyond controlling blood sugar, most doctors will recommend you try diet and lifestyle modifications first—before you try a drug.

Many people with diabetes, however, also have high blood pressure and/or elevated cholesterol, or have been diagnosed with coronary artery or vascular disease. If you are in this category, your doctor may prescribe a diabetes drug when you are diagnosed, along with diet and lifestyle changes and classes in diabetes self-management.

Our Recommendations

Six classes of oral medicines (and 12 individual drugs) are now available to help the 25.8 million people in the U.S. with type 2 diabetes control their blood sugar when diet and lifestyle changes are not enough. Our evaluation of these medicines found the following:

  • Newer drugs are no better. Two drugs from a class called the sulfonylureas and a drug named metformin have been around for more than a decade and work just as well as newer medicines. Indeed, several of the newer drugs, such as Januvia and Onglyza, are less effective than the older medications.
  • Newer drugs are no safer. All diabetes pills have the potential to cause adverse effects, both minor and serious. The drugs’ safety and side effect “profiles” may be the most important factor in your choice.
  • The newer drugs are more expensive. The newer diabetes medicines cost many times more than the older drugs.
  • Taking more than one diabetes drug is often necessary. Many people with diabetes do not get enough blood sugar control from one medicine. Two or more may be necessary. However, taking more than one diabetes drug raises the risk of adverse effects and increases costs.

Taking effectiveness, safety, adverse effects, dosing, and cost into consideration, we have chosen the following as Consumer Reports Best Buy Drugs if your doctor and you have decided that you need medicine to control your diabetes:

These medicines are available as low-cost generics, costing from $4 to $35 a month. If you have been diagnosed with diabetes, we recommend that you try metformin first unless it’s inappropriate for your health status.

If metformin fails to bring your blood sugar into normal range, we recommend you add glipizide or glimepiride.

Effectiveness Comparison

Generic (and Brand) Names*

HbA1c Reduction (percentage points)

LDL Cholesterol Change

(mg/dL)

HDL Cholesterol Change

(mg/dL)

Triglyceride Change

(mg/dL)

Risk of Hypoglycemia

(% of people)

Weight Change

(lbs)

Glyburide

↓ 1.3-1.8

↓ 10-20

10-22

↑ 5-10

Glipizide

↓ 1.3-1.8

↓ 10-20

10-15

↑ 5-10

Glimepiride

↓ 1.3-1.8

↓ 10-20

9-14

↑ 5-10

Metformin

↓ 0.9-1.4

↓ 5-7

↓ 15-25

0-7

Pioglitazone (Actos)

↓ 0.9

↑ 8-12

↑ 5

↓ 35-45

0-3

↑ 5-10

Rosiglitazone (Avandia)

↓ 0.9

↑ 12-15

↑ 3

↑ 10-20

4-11

↑ 5-10

Repaglinide (Prandin)

↓ 0.8-2.0

↓ 10-15

11-32

↑ 5-10

Nateglinide (Starlix)

↓ 0.3-0.8

IE

IE

IE

13

IE

Acarbose (Precose)

↓ 0.6-0.9

↓ 10-15

0-5

Miglitol (Glyset)

↓ 0.4-0.9

IE

IE

IE

IE

IE

Sitagliptin (Januvia)

↓ 0.6-0.8

Low

Saxagliptin (Onglyza)

↓ 0.4-0.9

IE

IE

IE

IE

IE

Definitions: mg/dL= milligrams per deciliter of blood; HbA1c = hemoglobin A1c; LDL = low-density-lipoprotein; HDL= high-density-lipoprotein.

*Selected drugs and measures. For the complete table, see the full diabetes report at www.CRBestBuyDrugs.org.

A down arrow (↓) means a decrease or decline; an up arrow (↑) means increase; a diamond (◊) means no meaningful effect or change; and IE = insufficient evidence. Brand names are not given for drugs available as generics. Numbers are averages based on multiple studies.

Cost Comparison

Generic Name and Dose1

Brand Name (or Generic)

Number of Pills (per day)2

Total Daily Dose2

Average Monthly Cost3

Acarbose 25 mg tablet

Generic

Three

75 mg

$78

Acarbose 50 mg tablet

Generic

Three

150 mg

$85

Acarbose 100 mg tablet

Generic

Three

300 mg

$98

Glyburide 1.25 mg tablet

Generic

One

1.25 mg

$9

Glyburide 2.5 mg tablet

Generic

One

2.5 mg

$5

Glyburide 5 mg tablet

Generic

One

5 mg

$6

Glyburide 5 mg tablet

Diabeta

One

5 mg

$51

Glyburide micronized 6 mg tablet

Generic

One

6 mg

$7

Glipizide 5 mg tablet

Glucotrol

One

5 mg

$31

Glipizide 5 mg tablet

Generic

One

5 mg

$5

Glipizide 10 mg tablet

Glucotrol

One

10 mg

$51

Glipizide 10 mg tablet

Generic

One

10 mg

$4

Glipizide 5 mg tablet, sustained-release

Glucotrol XL

One

5 mg

$31

Glipizide 5 mg tablet, sustained-release

Generic

One

5 mg

$10

Glipizide 10 mg tablet, sustained-release

Glucotrol XL

One

10 mg

$55

Glipizide 10 mg tablet, sustained-release

Generic

One

10 mg

$20

Glimepiride 1 mg tablet

Amaryl

One

1 mg

$31

Glimepiride 1 mg tablet

Generic

One

1 mg

$7

Glimepiride 2 mg tablet

Amaryl

One

2 mg

$45

Glimepiride 2 mg tablet

Generic

One

2 mg

$8

Glimepiride 4 mg tablet

Amaryl

One

4 mg

$85

Glimepiride 4 mg tablet

Generic

One

4 mg

$14

Metformin 500 mg tablet

Glucophage

Two

1000 mg

$76

Metformin 500 mg tablet

Generic

Two

1000 mg

$14

Metformin 850 mg tablet

Glucophage

Two

1700 mg

$130

Metformin 850 mg tablet

Generic

Two

1700 mg

$24

Metformin 1000 mg tablet

Glucophage

Two

2000 mg

$157

Metformin 1000 mg tablet

Generic

Two

2000 mg

$35

Metformin sustained-release 500 mg tablet

Glucophage XR

One

500 mg

$40

Metformin sustained-release 500 mg tablet

Generic

One

500 mg

$8

Metformin sustained-release 750 mg tablet

Glucophage XR

One

750 mg

$60

Metformin sustained-release 750 mg tablet

Generic

One

750 mg

$25

Saxagliptin 2.5 mg tablet

Onglyza

One

2.5 mg

$282

Saxagliptin 5 mg tablet

Onglyza

One

5 mg

$280

Sitagliptin 50 mg tablet

Januvia

One

50 mg

$279

Sitagliptin 100 mg tablet

Januvia

One

100 mg

$275

Pioglitazone 15 mg tablet

Actos

One

15 mg

$246

Pioglitazone 15 mg tablet

Generic

One

15 mg

$176

Pioglitazone 30 mg tablet

Actos

One

30 mg

$381

Pioglitazone 30 mg tablet

Generic

One

30 mg

$277

Pioglitazone 45 mg tablet

Actos

One

45 mg

$419

Pioglitazone 45 mg tablet

Generic

One

45 mg

$296

Repaglinide 0.5 mg tablet

Prandin

Three

1.5 mg

$347

Repaglinide 1 mg tablet

Prandin

Three

3 mg

$344

Repaglinide 2 mg tablet

Prandin

Three

6 mg

$347

Nateglinide 60 mg tablet

Generic

Three

180 mg

$142

Nateglinide 60 mg tablet

Starlix

Three

180 mg

$238

Nateglinide 120 mg tablet

Generic

Three

360 mg

$142

Nateglinide 120 mg tablet

Starlix

Three

360 mg

$246

Miglitol 25 mg tablet

Glyset

Three

75 mg

$153

Miglitol 50 mg tablet

Glyset

Three

150 mg

$164

Miglitol 100 mg tablet

Glyset

Three

300 mg

$200

Metformin + glipizide 250 mg/2.5 mg tablet

Generic

One

250 mg/2.5 mg

$24

Metformin + glipizide 500 mg/2.5 mg tablet

Generic

One

500 mg/2.5 mg

$27

Metformin + glipizide 500 mg/5 mg tablet

Generic

One

500 mg/5 mg

$27

Metformin + glyburide 250 mg/1.25 mg tablet

Generic

Two

500 mg/2.5 mg

$37

Metformin + glyburide 500 mg/2.5 mg tablet

Glucovance

Two

1000 mg/5 mg

$96

Metformin + glyburide 500 mg/2.5 mg tablet

Generic

Two

1000 mg/5 mg

$41

Metformin + glyburide 500 mg/5 mg tablet

Glucovance

Two

1000 mg/10 mg

$100

Metformin + glyburide 500 mg/5 mg tablet

Generic

Two

1000 mg/10 mg

$31

Pioglitazone + metformin 15 mg/850 mg tablet

Generic

One

15 mg/850 mg

$160

Pioglitazone + metformin 15 mg/500 mg tablet

Generic

One

15 mg/500 mg

$159

Pioglitazone + metformin 15 mg/850 mg tablet

Actoplus Met

One

15 mg/850 mg

$188

Pioglitazone + metformin 15 mg/500 mg tablet

Actoplus Met

One

15 mg/500 mg

$205

Pioglitazone + metformin sustained-release 15 mg/1000 mg tablet

Actoplus Met XR

One

15 mg/1000 mg

$216

Pioglitazone + metformin sustained-release 30 mg/1000 mg tablet

Actoplus Met XR

One

30 mg/1000 mg

$417

Pioglitazone + glimepiride 30 mg/2 mg tablet

Duetact

One

30 mg/2 mg

$393

Pioglitazone + glimepiride 30 mg/4 mg tablet

Duetact

One

30 mg/4 mg

$387

Repaglinide + metformin 2 mg/500 mg tablet

Prandimet

Three

6 mg/1500 mg

$342

Saxagliptin+ metformin 2.5 mg/1000 mg tablet

Kombiglyze XR

One

2.5 mg/1000 mg

$146

Saxagliptin+ metformin 5 mg/500 mg tablet

Kombiglyze XR

One

5 mg/500 mg

$293

Saxagliptin+ metformin 5 mg/1000 mg tablet

Kombiglyze XR

One

5 mg/500 mg

$286

Sitagliptin + metformin 50 mg/500 mg tablet

Janumet

Two

100 mg/1000 mg

$284

Sitagliptin + metformin 50 mg/1000 mg tablet

Janumet

Two

100 mg/2000 mg

$300

Indicates the dose of that drug may be available for a low monthly cost through programs offered by chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

1. Selected drugs and doses. For the complete table, see our full diabetes report at www.CRBestBuyDrugs.org.

2. As commonly or usually recommended.

3. Prices reflect nationwide retail average for August 2012, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumer Reports is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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