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For Mayo Clinic patients with type 2 diabetes, the decision about which drug to try is in the cards.
Only six cards are in this unique deck. Each bears information about an aspect of diabetes care, such as weight change and daily routine. Patients pick the card of greatest interest and discuss with their doctor how it relates to different diabetes drugs.

Except for one card summarizing how well different diabetes drugs control blood sugar — and they all do, to varying degrees — there isn't one that explains treatment benefits. How well do they protect against the ravages of diabetes, such as heart disease?

This was no oversight on the part of Victor Montori, developer of the card guides. He simply doesn't have that information. When it comes to diabetes drugs, nobody does.

Therein lies the problem for diabetes patients and their doctors. They have nine classes of drugs — five of which were just approved in the past decade — from which to choose but relatively little information about their risks and benefits. So for the most part, patients opt for the drug that will pack on the fewest pounds or comes in a pill instead of a shot.

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"My patients can't choose diabetes medications on the basis of benefit. They only choose the least painful poison," says Montori, a Mayo endocrinologist. "It's not that we need better drugs. It's just that we need better information about the drugs we have."

The knowledge gap gained worldwide attention two weeks ago when a study posted on a medical journal's website suggested that the diabetes drug Avandia — one of the top-selling brand-name drugs of any kind — increases the risk of heart attacks.

Avandia won Food and Drug Administration approval in May 1999 because short-term studies showed it lowered blood sugar.

The agency — and most scientists — consider lower blood sugar to be the best "surrogate," or substitute, goal for diabetes drugs' main objective: reducing complications, such as heart attacks. If a drug lowers blood sugar, and high blood sugar is known to be a risk factor for major diabetes complications, then the drug probably lowers the risk of them, or so the thinking goes.

Determining whether a drug prevents heart attacks would take much longer and need larger studies because, even in diabetics, such events are fairly infrequent.

The new study, which pooled published results from 42 small, short-term clinical trials of Avandia, was far from conclusive, but it highlights the paucity of knowledge about the treatment benefits most important to diabetes patients.

There's no question Avandia and other diabetes drugs help control blood sugar to varying degrees, and elevated blood sugar is thought to be the main reason that diabetes increases heart disease risk. But drugs usually have more than one effect on the body. Sometimes only large, lengthy — and, drugmakers might argue, prohibitively expensive — clinical trials can reveal how a drug's benefits stack up against risks. Patients and doctors are left to assume that lower blood sugar will mean a longer, healthier life.

More of the subject at the link below,

Diabetics face risk on drug choices - USATODAY.com