A new study finds that these two diabetes drugs work best

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When compared with sitagliptin or glimepiride, study participants who took metformin with liraglutide or insulin glargine were able to reach and maintain target blood levels for longer periods.

A large-scale clinical trial discovered that two diabetes drugs are superior to the others.

Researchers from University of Minnesota The College of Medicine contributed to the finding that insulin glargine and liraglutide worked better in a large clinical trial that directly evaluated four drugs frequently used to treat type 2 diabetes. The results were recently published in The New England Journal of Medicine.

The GRADE study is the first of its kind to compare the effectiveness of four commonly used drugs to treat type 2 diabetes when added to metformin in people with short-term diabetes. I found that liraglutide was superior to glimepiride and sitagliptin in controlling blood sugar,” said Elizabeth Sequist, MD, chief of medicine at the U of M College of Medicine and endocrinologist at M Health Fairview. “This study provides a guide that clinicians can use in developing treatment plans with their patients.”

When compared with sitagliptin or glimepiride, patients receiving metformin plus liraglutide or insulin glargine reached and maintained target blood levels for longer. When compared to sitagliptin, which was the least effective at maintaining target levels, this translated to nearly six months of additional time with blood glucose levels in the target range. Age, gender, race, or ethnicity had no effect on how well treatment worked. However, none of the groups significantly outperformed the others.

The approach to lowering blood sugar in diabetes: a comparative efficacy study (GRADE) was launched in 2013 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 was started to treat diabetes in combination with metformin. While there is general agreement among healthcare professionals that metformin combined with diet and exercise is the best early approach in diabetes care, there is no consensus on what needs to be done next to keep high blood glucose under control.

References: “Lowering Blood Sugar in Type 2 Diabetes – Glycemic Outcomes” by David M. Nathan, MD, John M. Lachin, MD, Ashok Balasubramaniam, MD, Henry Burch, MD Medicine, John B. Nicole M. Butera, PhD, Robert M. Cohen, MD, Jill B. Crandall, MD, Stephen E. Kahn, MB, CHB, Heidi Krause-Steineroff, MS, Mary E. Larkin, RN, Nada Rasouli, MD , Margaret Tektin, DNP, Deborah J. Wexler, MD, and Naji Younes, PhD Sept. 22, 2022, Available here. New England Journal of Medicine.
DOI: 10.1056/NEJMoa2200433

“Glycemic Reduction in Type 2 Diabetes – Microvascular and Cardiovascular Outcomes” By David M. Nathan, MD, John M. Lachin, PhD, Ionot Bibo, PhD, Henry Burch, PhD Medicine, John B. , 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 Pope-Bosoy, MD, PhD, Michael Stevis, MD, Margaret Tectin , DNP, Marc Tributi, Ph.D., Deborah J. Kessler, MD and Naji Younis, Ph.D. Sept. 22, 2022, Available Here 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 resources and facilities. Material support in the form of donated medicines and supplies was provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc. Novo Nordisk, Roche Diagnostics, and Sanofi.

ClinicalTrials.gov No. NCT01794143.

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