Two diabetic medicines outperformed others in a big study.

Introduction

When researchers directly examined four medicines routinely used to treat type 2 diabetes, they found that insulin glargine and liraglutide performed the best at keeping blood glucose levels within the prescribed range. Treatment of high blood sugar is essential for maintaining good health in patients with type 2 diabetes. Metformin is the first-line therapy for treating type 2 diabetes, and all four of the drugs we looked at were used in conjunction with it. Research for this study was supported by the NIDDK of the National Institutes of Health.

About 90–95% of the more than 37 million Americans who are diabetic are also affected by type 2 diabetes. Complications of diabetes, such as nerve, kidney, and eye disorders, are substantially less common in people with diabetes whose blood glucose levels are kept in the near-normal range. In order to maintain stable blood sugar levels over time, most persons with type 2 diabetes need to take more than one medication.

The medical community is in agreement that metformin with diet and exercise is the best initial strategy for treating diabetes, but they can’t agree on how to effectively manage high blood glucose levels after that.

The 36 U.S. research sites participated in the 2013 Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study(link is external). In addition to metformin, the GRADE study compared four other significant drugs that had recently been authorized by the FDA for the treatment of diabetes. New England Journal of Medicine published two studies with significant findings (link is external).

Dr. Henry Burch, NIDDK’s project scientist for GRADE, explains that the study’s goal was to help doctors better treat patients with type 2 diabetes over the long term. Patients’ glucose levels, drug tolerance, and other factors will be taken into account when making treatment decisions; this is a major advance toward precision medicine in diabetes care.

Five thousand and forty-seven persons of various racial and ethnic backgrounds were included in the research because they had type 2 diabetes and were taking metformin. Patients were assigned to one of four different therapy groups at random. Metformin was combined with either sitagliptin, liraglutide, or glimepiride, all of which raised insulin levels, in three different groups. Long-acting insulin glargine U-100 was combined with metformin for the fourth group.

 

Metformin plus liraglutide or insulin glargine was associated with longer durations of target blood level achievement and maintenance than sitagliptin or glimepiride, according to this study’s findings after an average of four years of follow-up. When compared to sitagliptin, the least effective medication in maintaining goal levels, this amounted to around six months extra time with blood glucose levels in the target range. There were no differences in treatment outcomes by age, gender, race, or ethnicity.

 

The problem is that none of the permutations significantly outperformed the others. The difficulty in sustaining suggested objectives in many patients with type 2 diabetes is shown by the fact that, despite a drop in average blood sugar levels during the trial, approximately three quarters of all participants were unable to maintain the blood glucose target over four years.

“GRADE effectively indicates which medicines worked best at attaining and sustaining blood glucose objectives over time,” said Dr. David M. Nathan, head of the Massachusetts General Hospital Diabetes Center in Boston, and chair of the GRADE Study. To help persons with type 2 diabetes achieve long-term glucose control, “we still have more work to perform,” such as assessing various strategies and therapy combinations.

The results of the therapies were also compared to the risk of acquiring cardiovascular disease in those with diabetes. As compared to the other groups, those in the liraglutide group had the lowest incidence of cardiovascular disease.

Drug adverse effects were also investigated in the study, which found:

Even while cases of severe hypoglycemia (also known as a low blood glucose response) were infrequent overall, they were more common among those given glimepiride (2.2%).

Liraglutide was associated with a higher incidence of gastrointestinal side effects compared to the other three treatment arms.

And across the board, people lost weight. People in the liraglutide and sitagliptin arms dropped an extra 7 and 4 pounds, respectively, over the course of four years, compared to those in the glargine and glimepiride arms (less than 2 pounds).

 

“With various treatment choices available for type 2 diabetes, healthcare practitioners and patients often find it challenging to identify which medicine is appropriate for individual person,” stated NIDDK Director Dr. Griffin P. Rodgers. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is in a prime position to fund comparative effectiveness trials like GRADE, which will aid healthcare providers in providing evidence-based recommendations that improve the health of their patients and all people living with type 2 diabetes.

At the time of the study’s start, the FDA had not authorized SGLT2 inhibitors, a class of diabetic medication that is currently on the market.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funded the GRADE Study (U01DK098246). The American Diabetes Association, the Centers for Disease Control and Prevention, the National Heart, Lung, and Blood Institute, and the National Center for Advancing Translational Sciences also provided funding. Resources and space were made available by the VA. Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc., Novo Nordisk, Roche Diagnostics, and Sanofi have all contributed material assistance in the form of donated pharmaceuticals and supplies. This study is registered as NCT01794143 with ClinicalTrials.gov.

The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases funds and oversees fundamental and clinical research on some of the most prevalent, life-altering, and devastating diseases afflicting Americans. Research at the Institute focuses on a wide range of topics, including diabetes and other endocrine and metabolic illnesses; digestive diseases; nutrition and obesity; and renal, urologic, and hematologic disorders.

Conclusion

We have been able to deduce that when researchers directly examined four medicines routinely used to treat type 2 diabetes, they found that insulin glargine and liraglutide performed the best at keeping blood glucose levels within the prescribed range. If you have any questions or concerns about what is written here please comment in the discussion below. contact us Rovich Diagnostic Services for consultancy.