Off Diabetes Pills!

A recent article in the British Medical Journal by a Scottish general practitioner reminded me of a book about diabetes pills that we published 35 years ago telling much the same story.

The article, entitled “Bad Medicine: The Way We Manage Diabetes,” begins by stating that “Type 2 [adult-onset] diabetes is a modern plague largely brought on by lifestyle” and then proceeds to attack the pharmaceutical industry for its focus on lowering blood sugar without any evidence, except in the case of the drug metformin, that this results in increased survival or decreased major cardiovascular risk. He concludes by saying that in the U.K. alone, the money spent on diabetes drugs could employ 40,000 personal trainers, showing his preference for serious lifestyle intervention instead of drugs (especially for overweight, underactive adult-onset diabetics). The title “Bad Medicine” refers to the fact that too many doctors fail to dissent against the pharmaceutical approach to diabetes care.

When our book Off Diabetes Pills was published in 1978, none of the diabetes pills available in the U.S. had evidence, beyond lowering blood sugar, of a positive effect on mortality or a reduction in cardiovascular disease. Since that year, only metformin has been found to decrease cardiovascular risk such as heart attacks and stroke, making it the preferred drug for newly diagnosed diabetics. (Some of the older diabetes drugs have been found to reduce some complications of diabetes, such as eye, nerve or kidney damage.) Our book focused on the crucial importance of weight loss instead of drugs for the majority of Type 2 diabetics who are overweight, notably stating that diabetes pills could impair weight loss if patient and doctor think they have taken care of the illness and thus do not need to focus on diet or exercise.

A major reason for our writing this book was that back in the 1970s, there was already some evidence of harm from oral diabetes drugs. Since then, the number of harmful diabetes pills has greatly increased, with several so dangerous they had to be banned. These included phenformin, which caused often-fatal lactic acidosis, and troglitazone, which caused frequently fatal liver failure. Public Citizen petitioned to have both drugs banned. Most recently, the widely used rosiglitazone (AVANDIA) was banned in Europe in 2010 due to increased cardiovascular risk, including heart attacks and heart failure. Although it was seriously restricted but not banned in the U.S., the Food and Drug Administration is now unfortunately considering relaxing the restrictions, despite continuing evidence of harm.

Considering the long history of harmful and ineffective diabetes drugs, we say: Bring on the 40,000 (actually, considerably more in the U.S.) personal trainers!

As always, we advise people taking diabetes pills to consult their physicians before making any decision concerning the pills.