Metformin, diet cost-effective to avert diabetes (Reuters)

SAN DIEGO (Reuters) – Generic drug metformin is a cost-effective way to help prevent Type 2 diabetes in people at high risk of developing the chronic condition, according to a new economic analysis.

The study also found that intensive lifestyle changes -- individually tailored weight loss and exercise -- have a higher cost, but are more likely to succeed, with a ratio of cost versus benefits in line with other common medical interventions such as blood pressure medication.

When savings in the cost of medical care were balanced against the cost of the interventions, over a 10-year period, metformin saved $30 while the lifestyle program cost $1,500 per person, according the National Institutes of Health-funded study.

"I'm really stunned by these findings," said Dr. James Meigs, a physician in the clinical epidemiology unit and diabetes research unit at Massachusetts General Hospital in Boston. He said the study could revolutionize intervention guidelines for high-risk patients.

Meigs, who was not involved in the study, spoke at a meeting of the American Diabetes Association, which presented the research in San Diego.

The economic analysis came from seven years of follow-up on a diabetes prevention trial that was stopped when it became obvious that patients in both treatment groups did far better than those being given a placebo pill.

Over 10 years, treatment with metformin, a low-cost generic that reduces blood sugar, was found to decrease the chance of developing diabetes by 18 percent in high-risk patients, while lifestyle changes cut the risk by 34 percent.

Researchers then conducted an economic analysis to project the long-term outcomes, in terms of cost and quality of life, for both intensive lifestyle intervention and treatment with metformin.

It found that over 10 years, usage of metformin saved money while improving health outcomes.

"This is an intervention that should become widely implemented," said Dr. William Herman, professor of internal medicine at the University of Michigan and the study's co-author.

He said that only one in 10 medical interventions -- including things like prenatal care, childhood vaccines and flu shots -- actually save money.

The study found that the lifestyle intervention program, which aimed for 7 percent loss in body weight and 150 minutes per week of exercise, cost about $12,000 for each year of "quality-adjusted" life -- meaning it cost that much to purchase one year of life in good health.

Herman said those costs are in line with standard treatments such as beta-blockers for people who have had a heart attack or drugs for people with severely high blood pressure.

The investigator also said costs of the lifestyle intervention program tapered off in later years, with no drop in effectiveness, and costs could be lower if interventions were in a group format, rather than individualized plans.

Meigs said most patients found to be at high risk of developing diabetes prefer trying to lose weight and exercise before resorting to pills.

(Reporting by Deena Beasley; editing by John Wallace and Gunna Dickson)

Wal-Mart hikes branded diabetes drug prices-study (Reuters)

SAN DIEGO (Reuters) – Big-box retailers Wal-Mart Stores and Kmart, pioneers in the push to cut consumer prices for generic drugs, have been raising prices for the most popular brand-name diabetes drugs, according to a new study.

Wal-Mart, the world's largest retailer began in 2006 to sell some generic drugs in the United States for $4 per monthly prescription -- a tactic since adopted by a number of other pharmacy operators.

"Since 2008, everybody has lowered generic prices close to the level of Wal-Mart," said Dr. Ronald Tamler, an endocrinologist at New York's Mount Sinai Medical Center, and co-author of the price study. "But the differential in pricing for brand-name drugs is huge."

His study, presented here at the annual meeting of the American Diabetes Association, found that the differential between pharmacy prices for generic diabetes drugs fell 60 percent between 2008 and 2010, compared with an increase of 113 percent for brand-name drugs.

The study also showed that Wal-Mart raised prices for the most-prescribed branded diabetes treatments by 32 percent between 2008 and 2010, while Kmart, a unit of Sears Holding Corp, raised its branded prices by 35 percent. The increase over the same two-year period was 21 percent at other pharmacies, which includes chain drugstores, mail-order firms and independent pharmacies, according to the study.

Neither company responded to a request for comment.

The $4 generics have become a "loss leader" for stores looking to draw new customers, Tamler said.

"The message used to be to send uninsured and underinsured patients to Wal-Mart to get a great deal on generic drugs," he said. "Now, the message is to tell patients to shop around for their medications."

(Editing by Paul Simao)

(This article has been modified to correct paragraph 5 to indicate that the price changes refer to the differential between pharmacies. Also corrects paragraph 6 to show that Wal-Mart and Kmart price increases were for brand-name drugs)

Some Drugs for Rheumatoid Arthritis, Psoriasis May Cut Diabetes Risk (HealthDay)

TUESDAY, June 21 (HealthDay News) -- Some medications commonly used to treat rheumatoid arthritis and psoriasis may help patients with these autoimmune disorders lower their risk of developing diabetes, researchers say.

New research found that a particular class of disease-modifying antirheumatic drugs (DMARDs) known as tumor necrosis factor (TNF) inhibitors and the antimalarial drug hydroxychloroquine can reduce diabetes risk by 38 percent and 46 percent, respectively, in people with rheumatoid arthritis or psoriasis.

"If you have rheumatoid arthritis or psoriasis, you may be at an increased risk of diabetes, and a number of different antirheumatic drugs may reduce your future risk of diabetes," said study author Dr. Daniel Solomon, chief of clinical science in rheumatology at Brigham and Women's Hospital in Boston.

However, Solomon was quick to point out that this was an observational study, and does not prove a cause-and-effect relationship between taking these medications and a reduced risk of diabetes. He said that for people who already have to take these drugs for other conditions, this research shows that there may be an added benefit with taking some of them.

The findings are published in the June 22/29 issue of the Journal of the American Medical Association.

Using statistics from two large health insurance company databases -- one in Canada and one in the United States -- the researchers reviewed data on people who had either rheumatoid arthritis or psoriasis. From a group of 121,280, the researchers immediately excluded the 12,996 who already had a diabetes diagnosis.

"These patients are at high risk of type 2 diabetes. This study found that about 10 percent already have it, which is higher than would be expected in the general population," said Dr. Joel Zonszein, director of the clinical diabetes program at Montefiore Medical Center in New York City.

The investigators then looked for those who had a prescription for at least one of the medications used for these conditions, and found that 13,905 were taking at least one of these drugs. The researchers further divided the group into four subgroups: those taking TNF inhibitors with or without other DMARDs; people taking methotrexate without a TNF inhibitor or hydroxychloroquine; hydroxychloroquine without TNF inhibitors or methotrexate; or other DMARDs without TNF inhibitors, methotrexate or hydroxychloroquine.

The study found that the rate of diabetes diagnoses over 12 years was 19.7 per 1,000 person-years for TNF inhibitors, 22.2 for hydroxychloroquine, 23.8 for methotrexate and 50.2 for other DMARDs. Compared to the other DMARDs, this translates to a reduced risk of 38 percent for TNF inhibitors, 23 percent for methotrexate and 46 percent for hydroxychloroquine.

Solomon said in an adjusted analysis, hydroxychloroquine and TNF inhibitors were the two types of drugs that appeared to make a significant difference in diabetes risk. These drugs are sold under brand names such as Plaquenil (hydroxychloroquine) and Enbrel, Humira and Remicade (TNF inhibitors).

Solomon said the reason these drugs might be protective isn't known, but the researchers suspect they reduce inflammation, which reduces insulin resistance and diabetes.

"Careful treatment of inflammatory conditions may reduce your future risk of diabetes," Solomon added.

"In a population with a very high incidence of diabetes, some medications may prevent or slow down the process of type 2 diabetes," said Zonszein.

Both experts added that these medications may have significant side effects. In addition, they can be expensive.

"The question is always, 'Is it worth giving these drugs?' You may prevent diabetes, but in doing so, will you create other problems?" said Solomon, who added that the information from this study might be helpful in selecting one treatment regimen over another for people with rheumatic diseases.

More information

Learn more about rheumatoid arthritis and disease-modifying antirheumatic drugs (DMARDs) from the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. They also have more information on psoriasis.