These two popular diabetes drugs outperformed the others in a new study

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  • Of the 37 million Americans with diabetes, about 90-95% have type 2 diabetes, according to Centers for Disaster Control and Prevention.
  • In a clinical trial directly comparing 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 sugar levels to some extent 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 – worked “modestly” better at helping people maintain their blood sugar levels.

All four drugs – including glimepiride and sitagliptin – improved blood sugar levels to some extent when added to metformin, a first-line treatment for type 2 diabetes, according to the study.

Keeping blood sugar levels within the recommended range can help reduce the risk of type 2 diabetes complications, such as cardiovascular disease, kidney damage, nerve damage, and vision problems.

Of the 37 million Americans with diabetes, about 90-95% have type 2 diabetes, according to Centers for Disaster Control and Prevention.

“Knowing that we are battling an obesity epidemic and that type 2 diabetes trends are on the rise, even in pediatric patients, gives healthcare providers more tools to help achieve [blood glucose] control,” said Dr Ilan Shapiro, chief health correspondent and chief medical affairs officer at AltaMed Health Services in Los Angeles, who did not participate in the research.

However, despite the improvements seen with all four drugs, nearly three-quarters of study participants were unable to maintain their blood sugar levels within the recommended range during the 5-year follow-up period.

“The overall results of the ongoing trial highlight the difficulty of reaching and maintaining the recommendations [blood glucose] levels in participants with type 2 diabetes,” the researchers wrote, “even in a clinical trial in which all care [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 recruited 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.

This “multicultural patient base … helps to better understand how different groups in our communities can be served,” Shapiro said.

Researchers randomly assigned participants to receive one of four drugs 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 period, participants taking liraglutide or insulin glargine were able to reach and maintain their blood sugar levels within the recommended range for the longest time, compared to those taking sitagliptin or glimepiride.

Glargine 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 sugar levels did not differ by age, gender, race or ethnicity.

However, people who entered the study with higher blood sugar levels had “progressively worse metabolic outcomes” with sitagliptin compared with the other treatments, the researchers said in the paper.

The results were published online September 21 in The New England Journal of Medicine in the form of two articles, one on blood glucose results and another on the cardiovascular outcomes.

The study also looked at the effects of the drugs on the risk of developing diabetes-related cardiovascular disease. People taking liraglutide had a lower risk of cardiovascular disease overall, compared to those taking either of the other drugs, the researchers found.

The researchers also looked at the side effects of the drugs and found:

  • Severe hypoglycaemia – low blood glucose – was rare, but occurred more frequently in people taking glimepiride. Shapiro said this side effect is concerning enough that it should be “monitored and managed” by patients and their doctors.
  • Gastrointestinal side effects were more common in people taking liraglutide than in those taking either of the other medicines.

Additionally, 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 drug 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. ‘study.

Additionally, the researchers said in the article that during the trial, participants’ medications were frequently adjusted, which “may not reflect the slow pace of medication adjustments in the clinical setting.”

Nevertheless, the study results could help doctors and patients choose the best drug treatments for type 2 diabetes.

“For a long time, we had the ‘gold standard’ of 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 prescription drugs, people can also help control their blood sugar by eating well, staying physically active and maintaining a healthy weight.

“Diabetes isn’t just a ‘sugar problem,’ it requires a change in the way we think about health,” Shapiro said. So we “need to have a multidimensional approach: healthy eating, moderate-intensity movement, good sleep habits, and mental health support.”

Moreover, he believes that communities can benefit from the services of community health workers – known in Spanish as promotions Where promoters — which can help guide patients towards wellness.

“Medication is a key part of the conversation,” he said, “but we can’t forget the complex life we ​​live.”


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