Metformin Is Still Tops for Diabetes, Says Study Review
Linda von Wartburg
8 August 2007
http://www.diabeteshealth.com/read/2007/08/08/5365.html
That old standby, metformin, is still your best bet. In fact, there is no benefit in taking the newer oral medications unless you can't tolerate the older ones.

That was the conclusion of researchers from Johns Hopkins University who examined 216 controlled studies and two systematic reviews in order to compare older oral medicines (second-generation sulfonylureas and metformin) and newer medications (thiazolidinediones, meglitinides, and alpha-glucosidase inhibitors) with regard to medium-term effects on A1c levels, lipid levels, body weight, and adverse outcomes.

Overall, the researchers found metformin to have the best benefit to risk ratio. Metformin was similar to or even better than the other oral medicines with regard to blood sugar control and lipid levels, though it was associated with greater risk of gastrointestinal problems.

In addition, it did not cause the 2.2 to eleven pound weight gain associated with almost all the other medicines. Second-generation sulfonylureas did pretty well too, apart from a greater risk of hypoglycemia.

Compared with newer agents, both metformin and sulfonylureas had three distinct advantages: longer use in practice, more information about longer-term effects, and lower cost. Metformin is available generically for about $40 monthly, for example, while Avandia can cost over $250 monthly.

Thiazolidinediones (like Actos and Avandia) were found to have a lower risk for hypoglycemia and a small beneficial effect on healthy cholesterol (HDL) levels, but were no better at lowering blood glucose and were also associated with adverse effects on bad cholesterol (LDL), weight, and risk of congestive heart failure.

(The researchers noted that large, longer-term comparative studies are still needed on outcomes such as myocardial infarction, chronic kidney disease, and cardiovascular mortality, as this review focused only on medium-term effects.)

The study review, which was commissioned in May 2005 by the federal Agency for Healthcare Research and Quality, has been used by Consumer Reports as the basis for its "best buy" evaluations of oral diabetes medications. In sum, Consumer Reports concluded that newer drugs are no better, no safer, and certainly more expensive.

Sources: Annals of Internal Medicine, September 2007
Medline Plus

看不懂,麻烦那位翻译过来.

我看懂了大标题,对糖尿病人来说二甲双胍依然是头等良药,正确!

That old standby, metformin, is still your best bet. In fact, there is no benefit in taking the newer oral medications unless you can't tolerate the older ones.
二甲双胍，虽然已经在临床应用很多年，但是仍然是糖尿病患者的最佳选择。事实上，除非原有口服药已经不能控制你的病情，否则采用新的口服降糖药并没有什么好处。

That was the conclusion of researchers from Johns Hopkins University who examined 216 controlled studies and two systematic reviews in order to compare older oral medicines (second-generation sulfonylureas and metformin) and newer medications (thiazolidinediones, meglitinides, and alpha-glucosidase inhibitors) with regard to medium-term effects on A1c levels, lipid levels, body weight, and adverse outcomes.
Johns Hopkins大学进行了216例对照试验和两项系统的回顾，以比较老的口服降糖药（二代磺脲类－优降糖等和二甲双胍）和新的口服降糖药（噻唑烷二酮－文迪雅，瑞格列奈－诺和龙和α一葡萄糖苷酶抑制剂一拜唐苹）,这个中期试验比较了两组受试者的糖化血红蛋白水平，血脂水平，体重和所带来的其他不良影响，研究结果如下：

Overall, the researchers found metformin to have the best benefit to risk ratio. Metformin was similar to or even better than the other oral medicines with regard to blood sugar control and lipid levels, though it was associated with greater risk of gastrointestinal problems.
总体来说，研究认为二甲双胍的风险最低。在血糖、血脂的控制方面、二甲双胍和其他降糖药降糖药相比水平相当，或者可以说比别的降糖药效果要更好，尽管它可能导致胃肠道的不良反应。

In addition, it did not cause the 2.2 to eleven pound weight gain associated with almost all the other medicines. Second-generation sulfonylureas did pretty well too, apart from a greater risk of hypoglycemia.
而且，几乎其他的所有降糖药都会导致2.2到11磅的体重增加，但是二甲双胍不会。二代磺脲类这一点也同样出色，但是会伴随较大的低血糖风险。

Compared with newer agents, both metformin and sulfonylureas had three distinct advantages: longer use in practice, more information about longer-term effects, and lower cost
. Metformin is available generically for about $40 monthly, for example, while Avandia can cost over $250 monthly.
和其他新一代降糖药比较，二甲双胍和优降糖都有三个显而易见的优点：第一是经过长年临床验证过的，第二长期服用这类药物的相关信息很多；第三治疗费用低，例如，二甲双胍的每个月费用只要40美元，而文迪雅要250美元；

Thiazolidinediones (like Actos and Avandia) were found to have a lower risk for hypoglycemia and a small beneficial effect on healthy cholesterol (HDL) levels, but were no better at lowering blood glucose and were also associated with adverse effects on bad cholesterol (LDL), weight, and risk of congestive heart failure.
噻唑烷二酮类药物（艾可拓和文迪雅）被证明有较低的低血糖风险，可以略微改善高密度脂蛋白胆固醇水平，但是在降低血糖方面疗效一般，而且有可能导致低密度脂蛋白胆固醇升高的副作用和充血性心脏病

(The researchers noted that large, longer-term comparative studies are still needed on outcomes such as myocardial infarction, chronic kidney disease, and cardiovascular mortality, as this review focused only on medium-term effects.)
（该试验的研究人员注意到，需要更大型，更长期的对照试验来从心肌梗塞、慢性肾脏病变和心血管死亡率这些方面来进行比较，此次试验还是集中在中期影响上来进行回顾的）

The study review, which was commissioned in May 2005 by the federal Agency for Healthcare Research and Quality, has been used by Consumer Reports as the basis for its "best buy" evaluations of oral diabetes medications. In sum, Consumer Reports concluded that newer drugs are no better, no safer, and certainly more expensive.
此项研究的回顾于2005年5月由the federal Agency for Healthcare Research and Quality发布，已经被《消费者报告》用来作为口服糖尿病药物评价的基础...。总之，《消费者报告》得出结论新的糖尿病药物并非更好，而且确实更贵。

Sources: Annals of Internal Medicine, September 2007
Medline Plus

感谢网友：mimimiao帮忙翻译过耒！佩服呀！

我从昨天起将【拜唐苹】改为【二甲双胍】（达美康）了，一方面【拜唐苹】价格太贵，另一方面我感觉【二甲双胍】更适合我。
       我有胃病，服用【二甲双胍】后没有发现药物反应，昨天午餐后2h血糖为5.4mmol/L，昨天晚上故意多吃点东西，今天空腹血糖为6.2mmol/L。

《消费者报告》得出结论新的糖尿病药物并非更好，而且确实更贵。
      服用磺脲类药物是“鞭打病牛”，就是卖胰岛素增敏剂的一种说法！

你象一支【来得时】卖三百多元，效果就那么好吗？未必！

我就是“达美康+二甲双胍”改成的“糖适平+拜糖平”，降糖效果是要差些。我是不是又要改回去？如果只看副作用哪一组要小一些？

偶在服卡博平＋长秀霖10Ｕ血糖控制的可以能否换成二甲，另胰岛素能减量或停了，前几天化验了糖化血红蛋白６请给个意见谢了