- Of the 37 million Americans who have diabetes, approximately 90% to 95% have type 2 diabetes, according to the
Centers for Disease Control and Prevention.
- In a clinical trial that directly compared different drugs used to treat type 2 diabetes, researchers found that two drugs – insulin glargine and liraglutide – worked “modestly” better.
- All four drugs tested — including glimepiride and sitagliptin — improved blood glucose levels somewhat when added to metformin.
In a large clinical trial directly comparing four drugs used to treat type 2 diabetes, researchers found that two drugs — insulin glargine and liraglutide — work “modestly” better at helping people maintain blood sugar levels.
The study showed that all four drugs – including glimepiride and sitagliptin – improved blood glucose levels somewhat when added to metformin, a first-line treatment for type 2 diabetes.
It can help to keep blood sugar levels within the recommended range Reduce the risk of complications Type 2 diabetes, such as cardiovascular disease, kidney damage, nerve damage, and vision problems.
Of the 37 million Americans who have diabetes, approximately 90% to 95% have type 2 diabetes, according to the
“Knowing that we are fighting an obesity epidemic and that trends in type 2 diabetes are on the rise, even in pediatric patients, this provides more tools for health care providers to help achieve [blood glucose] control,” said Dr. Ilan Shapiro, Chief Health Correspondent and Chief Medical Officer at Tamed Health Services in Los Angeles, who was not involved in the research.
However, despite improvements noted with all four drugs, nearly three-quarters of study participants were unable to maintain blood sugar levels within the recommended range over the 5-year follow-up period.
“The overall results of the current experience highlight the difficulty of achieving and maintaining recommendations [blood glucose] “Levels in participants with type 2 diabetes,” the researchers wrote, “even in a clinical trial where all care [including medications] It is provided free of charge. “
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.
The researchers enrolled 5,047 people with type 2 diabetes who were already taking metformin.
Nearly two-thirds of participants were white, one-fifth were black, and nearly one-fifth identified as Hispanic or Latino.
“The multicultural patient base … helps to better understand how to serve different groups in our communities,” Shapiro said.
The researchers randomly assigned participants to receive one of the four medications along with metformin.
Sitagliptin, liraglutide, and glimepiride work by increasing insulin levels. Insulin glargine is a long-acting insulin.
The researchers followed the participants for an average of 5 years.
During this time, participants taking liraglutide or insulin glargine were able to achieve and keep their blood sugar levels within the recommended range for the longest time, compared to those taking sitagliptin or glimepiride.
Glagine was most effective in helping people maintain target blood sugar levels; sitagliptin was the least effective.
The researchers found that the effect of the drugs on blood glucose levels did not differ with age, gender, race, or ethnicity.
However, the researchers said in the paper that people who started the study with higher blood glucose levels had “progressively worse metabolic outcomes” with sitagliptin than with the other treatments.
The study also looked at the effects of medications on diabetes-related cardiovascular disease risk. Researchers have found that people who take liraglutide have a lower risk of developing cardiovascular disease in general, compared to those who take one of the other medications.
The researchers also examined the side effects of the medications, and found:
- Severe hypoglycemia – low blood glucose levels – was uncommon, but occurred more frequently in people taking glimepiride. Shapiro said this side effect is worrisome enough that it needs to be “monitored and managed” by patients and their doctors.
- Gastrointestinal side effects were more common in people taking liraglutide than in those taking one of the other medications.
In addition, people taking liraglutide or sitagliptin lost more weight (7.7 pounds and 4.4 pounds, respectively) than those taking glargine or glimepiride (less than 2 pounds).
One limitation of the study is that it did not include a type of medication used to treat type 2 diabetes called SGLT2 inhibitors, which were not approved by the Food and Drug Administration at the start of the study.
In addition, the researchers said in the paper that during the trial, participants’ medications were frequently adjusted, which “may not reflect the slow rate of drug modifications in the clinical setting.”
However, the study results may help clinicians and patients determine the best drug treatments for type 2 diabetes.
“We’ve had for a long time the ‘gold standard’ for metformin and insulin,” Shapiro said. “Now we are moving forward with a better understanding of how to help our patients with current medications.”
In addition to prescribed medications, people can also help
“Diabetes is not just a ‘sugar problem,’ it requires a change in the way we perceive health,” Shapiro said. So we “need a multidimensional approach: a healthy diet, moderate intensity movement, good sleep habits, and mental health support.”
In addition, it is believed that communities can benefit from the services of
“Medications are an essential part of the conversation,” he said, “but we can’t forget the complex lives we live.”