Metformin controls blood sugar best. And?

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After evaluating the effects of several diabetes medications on blood glucose control, the American College of Physicians (ACP) has found that, although most drugs worked equally well, metformin was a cut above the rest in reducing blood sugar levels when used alone or in combination with other treatments. Thus, the ACP is now recommending that physicians use metformin as the first line of therapy for their type 2 diabetes patients; a second medication should be added to metformin if further lifestyle changes or the drug fail to adequately reduce blood sugar levels.

But ACSH s Dr. Gilbert Ross wonders whether there is actually evidence in support of any benefits of rigorously controlled blood glucose levels. Thus far, he says, I haven t been able to find any linkage between tighter blood sugar control and a significantly lower risk of cardiovascular disease or adverse kidney or neurological outcomes in type 2 diabetics. Indeed, in the ACP analysis, which was published in the Annals of Internal Medicine, Dr. Ross found that, although metformin was shown to reduce body weight and improve cholesterol profiles, there was insufficient evidence to demonstrate a beneficial impact on cardiovascular disease or any other clinical outcome.