TUESDAY, June 29, 2021 (HealthDay Information) — You’ve got type 2 diabetes, and you’re already taking an previous standby drug, metformin. However you continue to need assistance controlling your blood sugar levels. Which medicine can be the very best?
New analysis pitted a number of diabetes medicine in opposition to one another and got here up with a solution: The diabetes medicine Lantus and Victoza had been higher at controlling blood sugar over time than Amaryl or Januvia.
“We have identified that sort 2 diabetes is a progressive illness, and these drugs, normally, don’t scale back or obliterate development, and that the power of those drugs to gradual the rise in glucose varies amongst them,” defined Dr. Steven Kahn, a professor of medication, metabolism, endocrinology and nutrition on the College of Washington in Seattle. He’s a member of the manager committee that oversaw the trial.
The aim was to see which of those medicine stored common blood sugar ranges within the advisable goal vary, at an A1C level of lower than 7%. A1C blood checks are a typical technique of gauging long-term blood sugar management.
“Once we have a look at the rise in A1C over time, it is clear that there are preliminary useful impacts of 1 drug over the opposite, however they have a tendency to fail at a really comparable price,” Kahn mentioned. “So, past the primary couple of years, all of the failure appears to be occurring on the identical price, however total failure was much less with Lantus and Victoza.”
Lantus (insulin glargine) and Victoza (liraglutide) are each injectable medicine, whereas Amaryl (glimepiride) and Januvia (sitagliptin) are tablets.
The examine, which was funded by the U.S. Nationwide Institutes of Well being, included greater than 5,000 folks with sort 2 diabetes, common age 57. The members, 20% of whom had been Black and 18% of whom had been Hispanic, had been randomly assigned to one of many 4 medicine together with metformin within the trial, which ran a mean of 4 years.
The researchers discovered that Lantus and Victoza had been the simplest in protecting A1C ranges below 7%, whereas Amaryl or Januvia had the bottom impact and better odds of letting A1C ranges rise above 7%.
The outcomes had been comparable throughout gender, race, ethnicity and age group.
Different findings included:
- Sufferers given Victoza and Januvia had been extra prone to shed weight than these taking Amaryl. These taking Lantus maintained a secure weight.
- Victoza brought on extra gastrointestinal unwanted effects, reminiscent of nausea, stomach ache and diarrhea, than the opposite medicine. Amaryl was linked to a better danger for low blood sugar than the opposite medicine.
- Victoza was linked to a decrease danger of coronary heart assault, stroke and different coronary heart and vascular problems than the opposite medicine.
Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York Metropolis, mentioned the examine confirms that these drugs are acceptable and needs to be used as a second-line remedy after metformin, or as a first-line remedy if metformin is not tolerated.
Messer famous that though among the newer medicine are costly, they’re coated by most medical insurance plans.
“I believe the one disservice of the examine is that I do not need folks to start out considering that you ought to be utilizing insulin [Lantus] as a second-line remedy,” she defined. “I believe that it does a disservice, as a result of if persons are reaching for insulin too rapidly due to this trial, that might be a disgrace.”
The findings had been introduced Monday on the digital annual assembly of the American Diabetes Affiliation. Findings introduced at medical conferences needs to be thought-about preliminary till printed in a peer-reviewed journal.
Dr. Joel Zonszein, an emeritus professor of medication at Albert Einstein Faculty of Drugs in New York Metropolis, was not stunned by the findings, however thinks the trial is outdated.
“It definitely proves that Victoza and Lantus are higher drugs to enhance blood sugar management when metformin shouldn’t be sufficient,” he mentioned.
The issue with the examine is that it did not embody different medicine that had been accredited by the U.S. Meals and Drug Administration when the examine started, so there could also be simpler drug combos which are but to be examined, Zonszein mentioned.
“We have to know what the very best mixture is for remedy of diabetes early within the illness and to not use the antiquated step-up method — what to do when the medicine fails? We now have a wonderful alternative of medicines, and there’s no cause to have people with diabetes not well-treated,” he added.
And when managing diabetes, treating blood sugar shouldn’t be the one consideration, Zonszein famous.
“We deal with every affected person and individualize regimens accordingly. Remedy consists of obesity, high cholesterol and hypertension, amongst others. We purpose to enhance and extend a superb high quality of life,” he mentioned. “For example, the load loss discovered with Victoza is necessary for a lot of, and never discovered with the opposite brokers within the examine. Victoza’s gastrointestinal unwanted effects are additionally well-known, and these are decreased when utilizing newer weekly medicine.”
Though blood sugar ranges are necessary, remedy goals to keep away from or delay the problems of diabetes, Zonszein mentioned.
As a result of stroke and heart attack are the frequent causes of dying amongst diabetes sufferers, remedy ought to embody drugs that forestall coronary heart assault, stroke and different coronary heart and vascular problems, in addition to kidney disease.
“The… trial is subsequently outdated, and does not assist folks or their well being care suppliers to make choices in 2021 — the prepare has left the station,” Zonszein mentioned.
“Remedy of diabetes has shifted in direction of individualizing remedy, utilizing correct drugs from the get-go. We now use drugs that don’t trigger low blood sugar or want frequent blood sugar checking. Definitely, we use drugs that may assist with weight reduction and trigger much less cardiovascular problems,” he defined.
Kahn mentioned he’s all for individualized remedy for sort 2 diabetes. He additionally needs that drug corporations would do head-to-head trials of the newer medicine to find out the very best mixture remedy.
For extra on sort 2 diabetes, head to the American Diabetes Association.
SOURCES: Steven Kahn, MD, professor, drugs, metabolism, endocrinology and diet, College of Washington, Seattle; Caroline Messer, MD, endocrinologist, Lenox Hill Hospital, New York Metropolis; Joel Zonszein, MD, emeritus professor, drugs, Albert Einstein Faculty of Drugs, New York Metropolis; June 28, 2021, presentation digital annual assembly, American Diabetes Affiliation assembly