Researchers compared four drugs for type 2 diabetes treatment in a study that began in 2013 and whose results were just recently published in The New England Journal of Medicine.
They found that two of these four medications outperformed the others in treating patients.
The four types of insulin injections tested in this study were sitagliptin, liraglutide, glimepiride, and glargine U-100 (glargine).
Insulin glargine and liraglutide were the two drugs that were found to be more effective for patients who participated in this experiment. These medications are approved by the U.S. Food and Administration for achieving and maintaining recommended blood sugar levels in type 2 diabetes.
The study was titled Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE). The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.
It is said that there is a general agreement that combining metformin (an anti-diabetic medication) with diet and exercise is the best early diabetic care, but there is no assurance of the next step in keeping high blood sugar levels in check.
The GRADE study enrolled 5,047 patients with type 2 diabetes from diverse racial and ethnic groups. In this treatment trial, GRADE also combined metformin with the four insulin injections listed above. Participants were divided into four groups, and each group was designed to take a combination of metformin with different insulin injections.
Three groups took metformin with a medicine that increased insulin levels: either sitagliptin, liraglutide, or glimepiride. One group took metformin with glargine, a long-acting insulin.x
According to the results after four years of follow-up, the group taking metformin plus glargine and the group taking metformin plus liraglutide maintained the target blood sugar levels better than the other two groups for the longest time.
These two groups had about six more months of treatment than participants taking a combination of metformin and sitagliptin, which was the least effective in maintaining target levels. Age, sex, race, or ethnicity were not factors in this result.
Nonetheless, none of the combinations was able to maintain the target blood sugar levels over four years, making it difficult for treating patients with type 2 diabetes.
“GRADE effectively shows which drugs worked best at achieving and maintaining blood glucose targets over time, but we need to establish even more effective strategies for the long-term maintenance of acceptable glucose levels,” said GRADE Study Chair Dr. David M. Nathan, director of the Massachusetts General Hospital Diabetes Center, Boston. “We still have more work to do, such as evaluating other interventions and treatment combinations to help people with type 2 diabetes achieve long-term glucose control.”
In checking the treatments’ effects on developing diabetes-related cardiovascular disease, researchers found that the patients using the liraglutide treatment experienced the least cardiovascular disease.
Some side effects of the treatments are also reported. Severe hypoglycemia (a low blood glucose reaction) was uncommon, but significantly affected the glimepiride group (2.2 percent of the participants) compared to other groups. The liraglutide group experienced more frequent gastrointestinal symptoms than the other three.
Participants also experienced weight loss, especially in the liraglutide and sitagliptin groups.
“With many treatment options available for type 2 diabetes, health care providers and patients can find it difficult to know which drug is best for which person,” said NIDDK Director Dr. Griffin P. Rodgers. “NIDDK stands uniquely poised to support comparative effectiveness trials like GRADE to help providers make evidence-based recommendations that lead to better health for their patients, and for all people living with type 2 diabetes.”
The GRADE Study was supported by a grant from NIDDK and some other basic research centers.