Americans with diabetes nearly doubled their spending on drugs for the disease in just six years, with the bill last year climbing to an eye-popping $12.5 billion, the Associated Press writes. And newer, more expensive meds are the reason, despite a lack of strong evidence for greater benefits and safety, according to researchers, who note there are more people being treated for diabetes.

The new study follows updated treatment advice for Type 2 diabetes, issued last week. In those recommendations, an expert panel told doctors to use older, cheaper drugs first. Another study adds to evidence that metformin - an inexpensive generic used reliably for decades - may prevent deaths from heart disease while the newer, more expensive Avandia didn’t show that benefit, the AP writes.

“We need to pay attention to this,” David Nathan, diabetes chief at Boston’s Massachusetts General Hospital, who wasn’t involved in the new studies, tells the AP. “If you can achieve the same glucose control at lower cost and lower side effects, that’s what you want to do.”

The studies, appearing in Monday’s Archives of Internal Medicine, were both funded by federal grants (here is the abstract for the main study and this is the metformin study).

In one, researchers looked at which pills and insulin docs prescribed and total med costs. Diabetes drug spending rose from $6.7 billion in 2001 to $12.5 billion in 2007, a period when costs dropped for metformin. More patients got multiple scrips as new classes of drugs arrived, and more patients with diabetes were seeing docs, increasing from 14 million patients in 2000 to 19 million in 2007.

“There’s been a remarkable change in diabetes treatments and remarkable increases in the cost of treatments over the past several years,” study co-author Caleb Alexander, assistant professor of medicine at the University of Chicago, tells the AP. “We were surprised by the magnitude of the changes and the rapid increase in the cost of diabetes care.”

Nearly 24 million Americans, 8 percent of the population, have Type 2 diabetes, which can lead to kidney failure, blindness and heart disease. Current guidelines say docs should prescribe metformin (about $30 a month) to lower blood sugar in newly diagnosed patients and urge them to eat healthy food and get more exercise. Other drugs can be added later to help patients who don’t meet blood sugar goals. The updated guidelines don’t include Avandia, which costs about $225 a month.

Susan Spratt, an endocrinologist at Duke University Medical Center, prescribes whatever it takes to lower her patients’ future risk of blindness and amputations. That can mean coupling more costly drugs with metformin to hit blood sugar goals. “I think cost-analysis is important from a public health standpoint,” Spratt tells the AP. “But when you’re sitting across from a patient, you want to use whatever is going to help them get control of their diabetes.”

In the other study, Johns Hopkins University researchers analyzed findings from 40 published trials of diabetes pills that measured heart risks. Compared to other diabetes drugs or placebo, metformin was linked to a lower risk of death from heart problems. The findings suggest Avandia has a possible increased risk for heart disease death, but that increase wasn’t statistically significant, meaning it could have been the result of chance.

Few of the studies lasted longer than six months, and the researchers cited a “critical need” for long-term studies of diabetes pills and heart risks. Last year, the FDA issued a safety alert on Glaxo’s Avandia after another pooled analysis of studies found a risk of heart attacks. In July, an FDA panel suggested the agency should require drugmakers to show new diabetes drugs don’t increase heart risks, the AP reminds us (back story).

A Glaxo spokeswoman tells the AP that FDA-approved labeling for Avandia says available data on the risk of heart attack are inconclusive and the medication has been used by more than 7 million patients.

Source: Associated Press