Wendy L. Bennett, MD, MPH and her colleagues wanted to know if the new types of medications that have been approved for the treatment of adult onset diabetes are any better than the standard treatment which has been on the market since winning approval from the FDA in 1995.

Dr. Bennet, who is an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, explained her investigation:

“Metformin works for most people. It’s cheaper, there’s a generic form ‘it’s tried and true.’ Our study shows that even though there are all these newer drugs, metformin works just as well and has fewer side effects. Diabetes is an enormous public health problem, and patients have difficult decisions to make about what medications they should be taking. Our study provides good information comparing drugs and can be used to inform those decisions.”

The use of metformin to reduce blood sugar levels has a long history, beginning in the 1920s when it was first synthesized. At that time diabetes was often treated with insulin and other drugs, until interest in metformin was rekindled in the ‘40s when reports showed that it was helpful in reducing blood sugar. French doctor Jean Sterne published the results of his clinical trial of the medication, the first such study, in 1957, and was consequently introduced into the United Kingdom in 1958. Canada began to treat diabetes with metformin in 1972, and the United States followed suit in 1995. Today metformin is probably the most widely prescribed medication for diabetes in the world, with over 42 million prescriptions for it filled in 2009 in the United States alone.

Type 2 diabetes, also known as adult onset diabetes, is a huge problem today in the US, with over 25 million Americans suffering from this serious illness. The annual price Americans pay for this epidemic is about $132 billion, and the figure is increasing, with most of the costs going to complications from this disease.

The research of Dr. Bennett showed that while most of the drugs available to treat diabetes do indeed lower blood sugar levels, metformin was consistently associated with fewer side effects. In addition, because the newer medications do not have generic alternatives for patients to purchase, metformin is considerably cheaper than its newer substitutes. For instance, in the case of Januvia 30 pills can cost almost $200, close to $7 per pill; metformin costs about $35 for 100 pills, or 35 cents each, a difference of a factor of 20.

Josyann Abisaab, MD is an emergency room physician in New York’s Presbyterian Hospital.