Health Day reporter
TUESDAY June 29, 2021 (HealthDay News) – You have Type 2 diabetes, and you are already taking an old rescue medicine, metformin. But you still need help controlling your blood sugar level. Which drug would be the best?
“We know that type 2 diabetes is a progressive disease and that these drugs, in general, do not reduce or erase the progression, and that the ability of these drugs to slow the rise in blood sugar varies, according to Dr. Steven. . Kahn, professor of medicine, metabolism, endocrinology and nutrition at the University of Washington in Seattle. He is a member of the executive committee which oversaw the trial.
The goal was to see which of these drugs was keeping the average blood sugar level within the recommended target range, at a A1C level less than 7%. A1C blood tests are a standard way to assess long-term blood sugar control.
“When we look at the increase in A1C over time, it is clear that there are initial beneficial effects of one drug over the other, but they tend to fail at a very similar rate. “Kahn said. “So beyond the first two years all failures seem to be happening at the same rate, but the overall failure was less with Lantus and Victoza.”
Lantus (insulin glargine) and Victoza (liraglutide) are both injectable drugs, while Amaryl (glimepiride) and Januvia (sitagliptin) are pills.
The study, funded by the US National Institutes of Health, involved more than 5,000 people with type 2 diabetes, an average of 57 years old. The participants, 20% of whom were black and 18% Hispanic, were randomly assigned to one of four drugs with metformin in the trial, which lasted an average of four years.
Researchers found that Lantus and Victoza were the most effective in keeping A1C levels below 7%, while Amaryl or Januvia had the weakest effect and the highest chance of leaving A1C levels. A1C exceed 7%.
The results were similar by gender, race, ethnicity and age group.
Other findings included:
- Patients receiving Victoza and Januvia were more likely to lose weight than those receiving Amaryl. Those who took Lantus maintained a stable weight.
- Victoza has caused more gastrointestinal side effects, such as nausea, abdominal pain, and diarrhea, than other medicines. Amaryl was linked to a higher risk of hypoglycemia than other drugs.
- Victoza was associated with a lower risk of heart attack, stroke, and other heart and vascular complications than other drugs.
Dr Caroline Messer, a endocrinologist at Lenox Hill Hospital in New York, said the study confirms that these drugs are appropriate and should be used as a second-line treatment after metformin, or as a first-line treatment if metformin is not tolerated.
Messer noted that although some of the newer drugs are expensive, they are covered by most health insurance plans.
“I think the study’s only disservice is that I don’t want people to start thinking you should be using insulin. [Lantus] as a second-line treatment, “she explained.” I think that is doing a disservice, because if people are looking for insulin too quickly because of this trial, that would be a shame. “
The results were presented Monday at the American Diabetes Association’s virtual annual meeting. Results presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Dr Joel Zonszein, professor emeritus of medicine at the Albert Einstein College of Medicine in New York City, was not surprised by the results, but believes the trial is outdated.
“It certainly proves that Victoza and Lantus are better drugs for improving blood sugar control when metformin is not enough,” he said.
The problem with the study is that it didn’t include other drugs approved by the U.S. Food and Drug Administration at the start of the study, so there might be more effective drug combinations that didn’t. have not yet been tested, Zonszein said.
“We need to know what is the best combination for treating diabetes at the onset of the disease and not using the outdated step-by-step approach – what to do when the drug fails? We have a great choice of drugs, and there is no reason. to have people with diabetes who are not treated well, “he added.
And when manage diabetes, treatment of blood sugar is not the only consideration, Zonszein noted.
“We treat each patient and personalize the plans accordingly. Treatment includes obesity, high cholesterol and hypertension, among others. We aim to improve and extend a good quality of life, ”he said. “For example, the weight loss seen with Victoza is significant to many, and not found with the other agents in the study. The gastrointestinal side effects of Victoza are also well known, and they are reduced with the use of new weekly medications. ”
Although blood sugar is important, treatment is aimed at avoiding or delaying complications from diabetes, Zonszein said.
Because stroke and heart attack are common causes of death in diabetic patients, treatment should include drugs that prevent heart attacks, strokes and other heart and vascular complications, as well as kidney disease.
“The (…) trial is therefore outdated and does not help people or their caregivers to make decisions in 2021 – the train has left the station,” Zonszein said.
“Diabetes treatment has evolved into individualized therapy, using appropriate medications from the start. We are now using drugs that do not cause hypoglycemia or need frequent blood sugar checks. Certainly, we are using drugs that can help with weight loss and cause fewer cardiovascular complications, ”he explained.
Kahn said he is all in favor of individualized treatment for type 2 diabetes. He also wants drug companies to do head-to-head trials of new drugs to determine the best combination treatment.
To learn more about type 2 diabetes, visit American Diabetes Association.
SOURCES: Steven Kahn, MD, professor, medicine, metabolism, endocrinology and nutrition, University of Washington, Seattle; Caroline Messer, MD, endocrinologist, Lenox Hill Hospital, New York; Joel Zonszein, MD, professor emeritus of medicine, Albert Einstein College of Medicine, New York; June 28, 2021, virtual annual meeting presentation, American Diabetes Association meeting