A type 2 diabetes drug in widespread use for more than a decade, metformin (originally sold as Glucophage), has been found to have distinct advantages over nine other, mostly newer medications used to control the chronic disease, according to Johns Hopkins researchers.

In their report published in the journal Annals of Internal Medicine, the Hopkins researchers found that metformin not only controlled blood sugar levels but also was less likely to cause weight gain and more likely than others to lower bad cholesterol levels in the blood.

Metformin is also far cheaper than most of the newer diabetes drugs, with 100 tablets available for only $6.99 at MyFloridaPharmacy.com.

“Sometimes newer is not necessarily better,” said lead researcher Dr. Shari Bolen, an internist at Hopkins. “Issues like blood sugar levels, weight gain and cost could be significant factors to many patients struggling to stay in good health."

The study found that all the commonly used oral medications worked much the same at lowering and controlling blood sugar levels, but metformin offered the same level of effectiveness without lowering glucose measurements too much, and it did so for a lower price.

Metformin was found to lower LDL or bad cholesterol by about 10 milligrams per deciliter of blood, while newer medications studied, the thiazolidinediones Actos (pioglitazone) and Avandia (rosiglitazone} (Avandia), have the opposite effect, increasing levels of artery-clogging fat.

Researchers say the main drawbacks to metformin are digestive problems and diarrhea.

Previous reports have found evidence that the medication leads to the buildup of lactic acid in the blood in people with moderate kidney or heart disease, and they note that it should not be prescribed to anyone with either of these conditions.

The main advantages to both newer thiazolidinediones were a small increase in HDL or good cholesterol, and less too-low blood sugar levels than three other older second-generation sulfonylureas -- Amaryl (glimepiride), Glucotrol (glipizide), and Micronase (glyburide).

In the study, Bolen and her colleagues reviewed the scientific evidence from 216 previous studies and compared each drug for its clinical effectiveness, risks and costs.

In addition to metformin, the thiazolidinediones and sulfonylureas, drugs included in their analysis were Prandin (repaglinide), Glyset (miglitol), Precose (acarbose) and Starlix (nateglinide).

The researchers found that glimepiride, glipizide, and glyburide led to more frequent instances of too-low blood sugar levels than the other drugs. The sulfonylureas and acarbose appeared to have no effect on bad cholesterol. And except for metformin and acarbose, drug treatment led to an increase in weight from 2 to 11 pounds.

Researchers also noted the increased risk of heart failure, albeit small (less than three people in a hundred), in people taking thiazolidinediones who did not have a history of heart disease.

Researchers say further studies are needed to compare the long-term effectiveness of one treatment to another and to compare drug effects on quality of life and life expectancy.

Additional research will also be needed to compare these findings with results for injectible medications for diabetes, most notably insulin, which was not included in the latest report.