But not all clinicians were quick to decry use of Actos or the TZD class. Dr. Joel Zonszein of Albert Einstein College of Medicine in New York City called the earlier European decision "precipitous and premature" because it was based on a retrospective study and found only a minor increase in cancer risk.
He added that triple therapy -- with metformin, a TZD, and incretins -- is an "excellent combination, particularly in the more aggressive type 2 diabetes we see nowadays."
"During the last three decades, studies have shown that treating diabetes early and aggressively results in much better outcomes," Zonszein said. "There is a need for medications such as Actos that can slow down the devastating results of the diabetes epidemic."
Green said that while the recent decisions in the U.S., France, and Germany have made his "antennae go up," they won't yet change his prescribing. He said he also hears a greater public health message within the controversy.
"I think the larger message is not about which drugs for diabetes, but about the ultimate foolishness of trying to fix the problem with drugs," Green said. "As long as we keep supersizing ourselves, eating too much and moving too little, we'll have this problem."
The FDA began its review of Actos and the potential risk of bladder cancer last September, and said it will continue to monitor data until the full 10-year study is complete.