TUESDAY, June 29, 2021 (HealthDay News) — you have diabetes type 2, and you are already taking an old extra medicine, metformin. But you still need help controlling yourself blood sugar level. Which medicine would be best?
“We know that type 2 diabetes is a progressive disease, and that these drugs, in general, do not reduce or eliminate progression, and the ability of these drugs to slow the rise in glucose varies between them,” Dr. Explained by Steven Kahn, Professor of Medicine, metabolism, Endocrinology and Nutrition at the University of Washington in Seattle. She is a member of the executive committee that oversees the trial.
The goal was to see which of these drugs kept average blood sugar levels within the recommended target range. A1C level less than 7%. The A1C blood test is a standard means of assessing long-term blood sugar control.
“When we look at the increase in A1C over time, it is clear that one drug has initial beneficial effects over another, but they fail at a very similar rate,” Kahn said. “So, beyond the first few years, all failure seems to happen at the same rate, but with Lantus and Victoza the overall failure was lower.”
Lantus (insulin glargine) and Victoza (liraglutide) are both injectable drugs, while Amaryl (glimepiride) and Januvia (sitagliptin) are tablets.
The study, which was funded by the US National Institutes of Health, involved more than 5,000 people with type 2 diabetes, an average age of 57. Participants, 20% of whom were black and 18% of whom were Hispanic, were randomly assigned to one. Of the four drugs in the trial, those with metformin lasted an average of four years.
The researchers found that Lantus and Victoza were most effective at keeping A1C levels below 7%, while Amaryl or Januvia had the least effect and the highest likelihood of allowing A1C levels to rise above 7%.
The results were similar across gender, race, ethnicity and age group.
Other findings include:
- Weight loss was more likely in patients given Victoza and Januvia than those taking Amaryl. Those taking Lantus maintained a stable weight.
- Victoza caused more gastrointestinal side effects, such as nausea, abdominal pain, and diarrhea, than the other drugs. Amaryl was associated with a higher risk of low blood sugar than other medications.
- Victoza was linked to a lower risk of heart attack, stroke, and other heart and vascular complications compared to other drugs.
Dr. Carolyn Messer, and endocrinologist at Lenox Hill Hospital in New York City, said the study confirms that these drugs are suitable and used as second-line treatment after metformin or as first-line treatment if metformin is not tolerated. should go.
Messer notes that although some new drugs are expensive, they are covered by most health insurance plans.
“I think the only disadvantage of the study is that I don’t want people to think you should be using insulin. [Lantus] As a second-line treatment,” she explained. “I think it does a disadvantage, because if people are accessing insulin too early because of this trial, it would be a shame.”
The findings were presented Monday at the American Diabetes Association’s virtual annual meeting. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
An emeritus professor of medicine at the Albert Einstein College of Medicine in New York City, Dr. Joel Zonszein wasn’t surprised by the findings, but thinks the test is out of date.
“This conclusively proves that Victoza and Lantus are better drugs for improving blood sugar control when metformin is not enough.”
The problem with the study is that it did not include other drugs that were approved by the US Food and Drug Administration when the study began, so there may be more effective drug combinations that have yet to be tested, Zonszein said.
“We need to know what is the best combination to treat diabetes early in the disease and not use the archaic step-up approach – what to do when medicine fails? We have a slew of drugs. Excellent choice, and there is no reason individuals with diabetes should not be treated well.”
and when diabetes management, Treating blood sugar isn’t the only consideration, Zonszein said.
“We treat each patient and vary the diet accordingly. Treatment includes obesity, high cholesterol and high blood pressure, among others. Our goal is to improve and prolong good quality of life.” “For example, the weight loss found with Victoza is significant for many people, and was not found with other agents in the study. Gastrointestinal side effects of Victoza are also well known, and these are reduced when using the newer weekly medications.”
Although blood sugar levels are important, treatment aims to avoid or delay complications of diabetes, Zonszein said.
Since the strokes and heart attack are common causes of death in diabetics, treatment should include drugs that prevent heart attacks, strokes and other heart and vascular complications, as well as kidney disease.
“…the test is therefore out of date, and does not help people or their health care providers decide in 2021 – the train has left the station,” Zonszein said.
“The treatment of diabetes has shifted towards personalized medicine using appropriate medications from the start. We now use drugs that are not the cause. low blood sugar Or frequent blood sugar checks are needed. Certainly, we use drugs that can help with weight loss and cause fewer cardiovascular complications,” he explained.
Kahn said he is in for personalized treatment for type 2 diabetes. He also wants drug companies to conduct head-to-head trials of new drugs to determine the best combination treatment.
For more information on type 2 diabetes, head over to 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 City; Joel Jonszin, MD, Emeritus Professor of Medicine, Albert Einstein College of Medicine, New York City; June 28, 2021, Presentation Virtual Annual Meeting, American Diabetes Association meeting