PITTSBURGH (KDKA) — Jerry Webb was diagnosed with type two diabetes a year ago. The disease runs in his family.

“All three of my siblings are diabetic, my dad, two of his sisters and an uncle,” he says.

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He changed his diet, exercises more, and takes a drug with a long track record called Metformin. It improves blood sugar, doesn’t cause weight gain, and has no long-term side effects. It lowers the amount of sugar released by the liver.

“Generally, Metformin is the first choice medication we would start for somebody with diabetes,” says Allegheny General Hospital endocrinologist Dr. Jennifer Holst. “There is not a consensus as to what the next choice should be. There’s a huge variety of different medications that are available with different pros and cons.”

There are few studies to guide what class of diabetes medications to choose when Metformin isn’t enough. Some studies suggest that insulin shots are the way to go as an add-on, but a study in the Journal of the American Medical Association points differently.

Researchers at the Nashville VA Medical Center followed several thousand veterans who added insulin or a group of drugs called sulfonylureas to their Metformin regimen.

“Between those two groups there were no differences in heart attacks or stroke hospitalization, but the group that added insulin had a higher risk for death from any cause,” explains lead researcher, Dr. Christianne Roumie at the Nashville VAMC.

“My general feeling is that people who are sicker are started on insulin. And they tried to take that into account when they did the analysis,” says Dr. Holst.

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The higher risk of death in the insulin group may not necessarily be from the drug itself, but some other factor.

Insulin is very effective in bringing down blood sugar quickly, especially for people who have very high readings or no insulin production on their own. But many patients are still concerned about injections and other side effects.

“Insulin is still a great medication, and it’s sometimes the best choice for a person. And I don’t think it should dissuade people from using insulin,” says Dr. Holst.

Jerry tests his blood sugars three times a week and is working hard to control his diabetes.

“When you make these changes, you’re going to have to keep it for the rest of your life,” he says.

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