Large studies test effectiveness of common diabetes drugs | health

Thursday, Sept. 22, 2022 (HealthDay News) — Two common diabetes medications appear to outperform the other two when it comes to controlling blood sugar levels, according to a large US trial.

trial Of more than 5,000 people with type 2 diabetes found that there are two injectable medications – long-acting insulin and liraglutide (Victoza) – It usually works better than two oral medications at keeping blood sugar levels under control.

Over a five-year period, patients taking either parenteral therapy spent more time with blood sugar in the recommended range—an average of an additional six months.

However, most of the study patients were unable to achieve this long-term goal. Experts said that underscores how difficult this task is for diabetics.

“Finally, treatment groups did not maintain optimal A1C levels in many patients for the long-term management of type 2 diabetes,” said researcher Dr. Henry Burch of the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

A1C It is a measure of the average blood sugar level over the past three months. When people have diabetes, the goal is to keep the A1C level below 7%.

In the trial, 71% of patients were unable to achieve this goal during the five-year follow-up period.

More than 37 million Americans have diabetes, the vast majority of whom have it type 2According to the NIDDK. In this form of the disease, the body loses its ability to properly use insulin, a hormone that transports sugars from food into the body’s cells to be used for energy.

As a result, sugar builds up in the bloodstream, which can damage blood vessels and nerves over time. Many diabetics suffer from complications such as heart disease, kidney failure, nerve damage in the feet and legs, and possibly eye diseases that can lead to blindness.

Controlling blood sugar is key to reducing this risk. To do this, most people with type 2 diabetes take the medication by mouth metforminIn addition to changing the diet and exercise.

New findings – published on September 22 in New England Journal of Medicine – Comes from an experiment launched nearly a decade ago and funded by the NIDDK. The goal was to determine which diabetes medications, when added to metformin, are most effective in helping patients maintain the recommended A1C target.

Just over 5,000 American adults with type 2 diabetes were randomized to add one of four treatments: insulin glargine (Lantos), a long-acting synthetic insulin; liraglutide; glimepiride (Amaryl), which belongs to a class of drugs called sulfonylureas; or sitagliptin (Januvia), a DPP-4 inhibitor.

Over a five-year period, patients taking either insulin or liraglutide were more successful in maintaining their A1C levels. About 67% saw their blood sugar above this goal at some point, versus 72% of glimepiride patients and 77% of sitagliptin patients.

On average, patients who had the injection treatments had about six more months in the target range, compared to the sitagliptin group.

Patients who had all treatments tended to lose weight or stay stable, but the weight loss was greater with liraglutide, which helped people shed an average of 7 pounds. (A different combination of the drug, sold as Saxenda, is approved as a weight-loss aid.)

In general, though, there has been no treatment performed at home.

The “important takeaway” from the trial, Burch said, is that when people don’t reach their A1C goal, they and their doctors should be open to switching medications or adding medications — as well as making healthy lifestyle changes.

There is no one-size-fits-all strategy, according to the diabetes expert who was not involved in the trial.

Dr. Roeland JW Middelbeek, MD, of the Joslin Diabetes Center in Boston, said that in the years since the study began, the guidelines have focused more on the importance of individualized treatment.

For any patient, he said, there are several factors to consider when making medication choices — including coexisting health conditions such as heart or kidney disease, whether weight management is a goal, and medication costs.

For patients, Middlebeck said, it’s important to work individually with your doctor to figure out the best treatment plan.

The researchers noted that there have also been other changes since the trial began in 2013. A new group of diabetes drugs, called SGLT2 inhibitors, are now available. They include drugs such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).

And in the past few years, recommendations supporting SGLT2 inhibitors and GLP-1 receptor antagonists (which include liraglutide) have emerged as preferred options for patients with heart or kidney disease.

But managing diabetes and preventing its complications requires more than controlling blood sugar. It’s also important to curb high blood pressure and high cholesterol, quit smoking and strive for a healthier weight, Burch said.

more information

The US National Institute of Diabetes and Digestive and Kidney Diseases provides an overview of type 2 diabetes mellitus

SOURCES: Henry Burch, MD, Program Director, Division of Diabetes, Endocrinology and Metabolic Diseases, US National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; Roeland JW Middelbeek, GP, and Assistant Investigator, Joslin Diabetes Center, and Instructor, Harvard Medical School, Boston; New England Journal of MedicineSeptember 22, 2022