Compared with sitagliptin or glimepiride, study participants who took metformin with liraglutide or insulin glargine were able to achieve and maintain their target blood levels for the longest periods of time.
A large-scale clinical trial has found that two diabetes drugs outperform the others.
Researchers at the University of Minnesota School of Medicine helped find that insulin glargine and liraglutide worked best in a large clinical trial that directly evaluated four drugs commonly used to treat type 2 diabetes. results were recently published in The New England Journal of Medicine.
“The GRADE study is the first to compare the effectiveness of four drugs commonly used to treat type 2 diabetes when added to metformin in people with short-term diabetes. It found that liraglutide was superior to glimepiride and sitagliptin in controlling blood sugar,” said Elizabeth Seaquist, MD, chair of the Department of Medicine at U of M School of Medicine and endocrinologist at M Health Fairview. “This study provides evidence that clinicians can use to develop treatment plans with their patient.”
Compared with sitagliptin or glimepiride, patients receiving metformin plus liraglutide or insulin glargine achieved and maintained their target blood levels for the longest time. Compared to sitagliptin, which was the least effective in maintaining target levels, this translated to almost six months of additional time with blood sugar levels in the target range. Age, sex, race or ethnicity had no impact on the effectiveness of a treatment. None of the combinations, however, significantly outperformed the others.
Launched in 2013, the GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness) study was conducted at centers across the country, including the University of Minnesota. It was designed to compare four major drugs approved by the Food and Drug Administration (FDA) at the time GRADE began treating diabetes in combination with metformin. Although there is a general consensus among healthcare professionals that metformin plus diet and exercise is the best early approach in diabetes care, there is no consensus. on what to do next to better control high blood sugar.
References: “Reducing Blood Glucose in Type 2 Diabetes—Glycemic Outcomes” by David M. Nathan, MD, John M. Lachin, Sc.D., Ashok Balasubramanyam, MD, Henry B. Burch, MD, John B. Buse, MD, Nicole M. Butera, Ph.D., Robert M. Cohen, MD, Jill P. Crandall, MD, Steven E. Kahn, MB, Ch.B., Heidi Krause-Steinrauf, MS, Mary E. Larkin, RN, Neda Rasouli, MD, Margaret Tiktin, DNP, Deborah J. Wexler, MD, and Naji Younes, Ph.D., September 22, 2022, New England Journal of Medicine.
DOI: 10.1056/NEJMoa2200433
“Reduced Blood Glucose in Type 2 Diabetes – Microvascular and Cardiovascular Outcomes” by David M. Nathan, MD, John M. Lachin, Sc.D., Ionut Bebu, Ph.D., Henry B. Burch, MD, John B. Buse, MD, Andrea L. Cherrington, MD, Stephen P. Fortmann, MD, Jennifer B. Green, MD, Steven E. Kahn, MB, Ch.B., M. Sue Kirkman, MD, Heidi Krause- Steinrauf, MS, Mary E. Larkin, RN, Lawrence S. Phillips, MD, Rodica Pop-Busui, MD, Ph.D., Michael Steffes, MD, Margaret Tiktin, DNP, Mark Tripputi, Ph.D., Deborah J. Wexler, MD and Naji Younes, Ph.D., September 22, 2022, New England Journal of Medicine.
DOI: 10.1056/NEJMoa2200436
The GRADE study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, the National Institute of General Medical Sciences, the National Center for the Advancement of Translational Sciences, the Centers for Disease Control and Prevention, and the American Diabetes Association. The Department of Veterans Affairs provided the resources and facilities. Material support in the form of drug and supply donations was provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc., Novo Nordisk, Roche Diagnostics and Sanofi.
ClinicalTrials.gov number: NCT01794143.
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