An advisory committee to the Food and Drug Administration concluded in July that the heavily advertised and widely prescribed diabetes drug rosiglitazone (Avandia) posed a greater heart-attack risk than older, cheaper, equally effective medications. That comes on the heels of even stronger evidence that the drug, along with its relative pioglitazone (Actos), increases the risk of heart failure.

Here’s our advice on the best way to safely and effectively treat diabetes.

The FDA initially approved rosiglitazone and pioglitazone because randomized clinical trials found that they helped control blood-sugar levels. But after several years of the drugs’ use outside of that carefully controlled setting, researchers began detecting unexpected heart risks, especially in people taking rosiglitazone.

In contrast, research continues to document the safety and efficacy of older diabetes drugs, especially metformin (Glucophage and generic). That medicine controls blood sugar as effectively as other diabetes drugs, lowers the level of “bad” LDL cholesterol, doesn’t trigger weight gain, and is less likely to cause a dangerously low blood-sugar level (hypoglycemia). Moreover, the generic version of the drug costs just $38 to $60 per month compared with $142 to $262 for each of the glitazones.

If you can’t take metformin or if it doesn’t adequately control your bloodsugar level, talk with your doctor about glimepiride (Amaryl and generic), glipizide (Glucotrol and generic), or glyburide (Diabeta, Micronase, and generic). Those drugs, called sulfonylureas,pose fewer heart risks than the glitazones, and their generic versions cost less as well.

If none of those options works for you and you’re at low risk of heart failure, you could consider pioglitazone. Or ask your doctor about exenatide (Byetta) and sitagliptin (Januvia), new drugs that might be safer than the glitazones.

For more information, see our free Best Buy Drug report on diabetes.

This article first appeared in the November 2007 issue of Consumer Reports onHealth.