By Amy Norton HealthDay Reporter
THURSDAY, Sept. 22, 2022 (HealthDay News) — Two common diabetes drugs appear to outperform two others when it comes to controlling blood sugar, a large U.S. study has found.
The trial involving more than 5,000 people with type 2 diabetes found that two injection medications — a long-acting insulin and liraglutide (Victoza) — typically worked better than two oral drugs at controlling blood sugar levels.
Over five years, patients who received both injection treatments spent more time with their blood sugar levels in the recommended range — an average of six additional months.
Still, most study patients were unable to achieve that long-term goal. Experts said it underscores how difficult that task is for people with diabetes.
“Ultimately, the treatment combinations did not maintain optimal A1C levels for the long-term treatment of type 2 diabetes in many patients,” said study researcher Dr. Henry Burch of the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
A1C is a measure of a person’s average blood sugar level over the past three months. When people have diabetes, the goal is to keep A1C below 7%.
In the study, 71% of patients were unable to achieve that goal during the five-year follow-up.
More than 37 million Americans have diabetes, the vast majority of whom have type 2, according to the NIDDK. In that form of the disease, the body loses its ability to properly use insulin, a hormone that transports sugars from food to body cells to be used for energy.
As a result, sugar builds up in the bloodstream, which can eventually damage blood vessels and nerves. Many people with diabetes develop complications such as heart disease, kidney failure, nerve damage in the feet and legs, and potentially blinding eye conditions.
Controlling blood sugar is key to reducing those risks. To do that, most people with type 2 diabetes take the oral drug metformin, along with diet changes and exercise.
The new findings — published Sept. 22 in the New England Journal of Medicine — come from a trial launched nearly a decade ago and funded by the NIDDK. The aim was to determine which diabetes medications, when added to metformin, were most effective in helping patients maintain the recommended A1C goal.
Just over 5,000 U.S. adults with type 2 diabetes were randomly assigned to add one of four treatments: insulin glargine (Lantus), a long-acting synthetic insulin; liraglutide; glimepiride (Amaryl), which belongs to a class of drugs called sulfonylureas; or sitagliptin (Januvia), a DPP-4 inhibitor.
Over five years, patients taking insulin or liraglutide were the most successful at maintaining their A1C levels. About 67% saw their blood sugar level rise above that target at some point, compared to 72% of glimepiride patients and 77% of sitagliptin patients.
On average, patients who received the injection treatments had about six additional months in the target range, compared to the sitagliptin group.
Patients across all treatments tended to lose weight or remain stable, but the weight loss was greatest with liraglutide, which helped people lose an average of 7 pounds. (Another formulation of the drug, sold as Saxenda, has been approved as a weight loss aid.)
On balance, however, no treatment was a home run.
A “key takeaway” from the trial, Burch said, is that when people don’t meet their A1C goal, they and their doctors should be open to switching or adding drugs — as well as making healthy changes. into lifestyle.
There is no one-size-fits-all strategy, according to a diabetes expert who was not involved in the study.
In the years since the study began, guidelines have placed greater emphasis on the importance of individualized treatment, said Dr. Roeland JW Middelbeek of the Joslin Diabetes Center in Boston.
For any patient, he said, there are multiple factors to consider when making medication choices — including co-existing health conditions such as heart or kidney disease, whether weight management is a goal, and medication costs.
So for patients, Middelbeek said, it’s important to work one-on-one with your doctor to find the best treatment plan.
There have also been other changes since the trial launched in 2013, the researchers point out. A new group of diabetes drugs called SGLT2 inhibitors is now available. They include medications such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
And in recent years, recommendations have been made supporting SGLT2 inhibitors and GLP-1 receptor agonists (including liraglutide) as options of choice for patients with pre-existing heart or kidney disease.
But managing diabetes and preventing its complications requires more than blood sugar control. Burch said it’s also critical to curb high blood pressure and high cholesterol, quit smoking, and aim for a healthier weight.
The US National Institute of Diabetes and Digestive and Kidney Diseases has an overview of type 2 diabetes.
SOURCES: Henry Burch, MD, program director, Division of Diabetes, Endocrinology and Metabolic Diseases, US National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.; Roeland JW Middelbeek, MD, staff physician, assistant investigator, Joslin Diabetes Center and instructor, Harvard Medical School, Boston; New England Journal of Medicine22 Sept. 2022
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