- Of the 37 million Americans with diabetes, approximately 90% to 95% have type 2 diabetes
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 “slightly” better.
- All four drugs tested – including glimepiride and sitagliptin – improved blood sugar levels to some extent when added to metformin.
In a large clinical trial that directly compared four drugs used to treat type 2 diabetes, researchers found that two drugs — insulin glargine and liraglutide — worked “modestly” better at helping people maintain their blood sugar levels.
All four drugs — including glimepiride and sitagliptin — improved blood sugar levels to some degree when added to metformin, a first-line treatment for type 2 diabetes, the study showed.
Keeping blood sugar levels within the recommended range can help reduce the risk of complications of type 2 diabetes, such as cardiovascular disease, kidney damage, nerve damage, and vision problems.
Of the 37 million Americans with diabetes, approximately 90% to 95% have type 2 diabetes
“Knowing that we are battling an obesity epidemic and that type 2 diabetes trends are increasing, even among pediatric patients, gives healthcare providers more opportunities to make that happen [blood glucose] control,” said Dr. Ilan Shapiro, chief health correspondent and medical affairs officer at AltaMed Health Services in Los Angeles, who was not involved in the research.
However, despite the improvements seen with all four drugs, nearly three-quarters of the study participants were unable to maintain their blood glucose levels within the recommended range over the 5-year follow-up period.
“The overall results of the current study underscore the difficulty of achieving and maintaining those recommended [blood glucose] Scores in participants with type 2 diabetes,” the researchers wrote, “even in an all-attendant clinical trial [including medications] 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.
Almost two-thirds of the participants were White, one-fifth were Black, and nearly one-fifth identified as Hispanic or Latinx.
This “multicultural patient base…helps to better understand how to care for diverse groups in our communities,” Shapiro said.
Researchers randomly assigned participants to one of four medications in addition to 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 reach and maintain their blood glucose levels within the recommended range for the longest time compared to those taking sitagliptin or glimepiride.
Glargine was most effective at helping people maintain target blood sugar levels; Sitagliptin was the least effective.
The researchers found that the drugs’ effect on blood sugar levels did not differ by age, gender, race or ethnicity.
However, people who started the study with higher blood glucose levels had “progressively worse metabolic outcomes” with sitagliptin compared to the other treatments, the researchers said in the study.
The results were published online on September 21 The New England Journal of Medicine as two papers, one on blood glucose results and another on cardiovascular results.
The study also looked at the effects of the drugs on people’s risk of developing diabetes-related cardiovascular disease. Researchers found that people taking liraglutide had an overall lower risk of cardiovascular disease than those taking any of the other drugs.
The researchers also looked at the side effects of the drugs and found:
- Severe hypoglycaemia – low blood sugar levels – was uncommon but was more common in people taking glimepiride. Shapiro said this side effect is of such concern that it needs to be “monitored and treated” by patients and their doctors.
- Gastrointestinal side effects were more common in people taking liraglutide than in people taking any of the other drugs.
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 any type of type 2 diabetes medication called SGLT2 inhibitors that were not approved by the Food and Drug Administration when the study began.
Additionally, the researchers said in the paper that participants’ medications were frequently adjusted during the study, which “may not reflect the slow rate of medication adjustments in the clinical setting.”
Nevertheless, the results of the study can help doctors and patients decide on the best medical treatment for type 2 diabetes.
“For a long time we had the ‘gold standard’ of metformin and insulin,” Shapiro said. “Now we are making progress with a better understanding of how we can help our patients with current medicines.”
In addition to prescription drugs, people can also help
“Diabetes is not just a ‘sugar problem,’ it requires a shift in how we perceive health,” Shapiro said. So we need “a multidimensional approach: healthy eating, moderate-intensity exercise, good sleep habits and mental health support.”
In addition, he believes communities can benefit from the services
“Medications are an important part of the conversation,” he said, “but we mustn’t forget the complex lives we lead.”