We all like to have the latest and greatest new stuff. IPhone 27, IPad 9, Prius, 3D TV. Far too often, this new technology is very expensive and has a tendency to break down. But despite these shortcomings, you need to admit it–buying the latest stuff is built into our DNA. But do you want your doctor to have this same attitude when it comes to your medications?
Many falsely belive that, once a new drug hits the market that the FDA has fully evaluated the safety profile of the drug. This couldn’t be further from the truth. The list of medications that were pulled off the market years after their release is quite long and covers all different classes of drugs used to treat many different conditions. It is not until years later, after the new drug has been used in a large number of patients, that some of the more dangerous side effects come to light.
We are certainly seeing this right now with diabetic treatments. The new medications that affect the GLP-1 pathway are all the rage. I have been very vocal in my own little personal disdain for the rapid adoption of this direction for diabetic treatments. There are some small hints as to what this class of drugs may have hiding in the deep dark basement of side effects, but it will be years yet before it hits the radar screen of the FDA for a closer look.
Metformin is a drug used to treat diabetes for many years and we’ve got a pretty good idea of what it does and doesn’t do. While I would never recommend a drug in lieu of lifestyle changes, and I feel that metformin only improves insulin sensitivity in the liver and not anywhere else in the body, metformin is probably a good place to start on the drug pathway.
This particular article evaluated how often doctors are putting newly diagnosed diabetic patients on metformin vs the newer, more expensive diabetic drugs and whether patterns changed from 2006 to 2008. There were some very simple but interesting findings:
- Patients treated with metformin increased from 14%
- Sulfonylureas use decreased from 8%
- Thiazolidinediones (TZD) use dropped 12.8%
- Prescriptions for dipeptidyl peptidase-4 (DDP-4) inhibitors went from 0.4% to 7.3% (for the math wizzess, this is an 18X increase
- Younger patients, women, and those on Medicare were least likely to initiate treatment with metformin
- Spending for patients who were not initiated on metformin was $1354 / year
- Metformin for a year was $232
- Again, for those math wizzes, this is a cost difference of approximately $1120 annually per patient
While it is good that the use of sulfonylureas and TZDs are dropping because these are just bad drugs to use for diabetes, it is disheartening to see the massive spike in the new class of drugs (DDP-4 inhibitors) despite the lack of a long term safety profile and the much greater cost.
I guess this means that many doctors are also falling prey to the “newest and greatest” when it comes to prescribing new drugs to their diabetic patients.