A large-scale clinical trial discovered that two diabetes drugs outperform others.
Researchers from the University of Minnesota Medical School contributed to the finding that insulin glargine and liraglutide worked best in a large clinical trial that directly evaluated four drugs frequently used to treat type 2 diabetes. The findings were recently published in The New England Journal of Medicine.
“The GRADE study is the first to compare the efficacy of four drugs commonly used to treat type 2 diabetes when added to metformin in people with short-duration diabetes. It found that liraglutide was superior to glimepiride and sitagliptin in controlling blood sugars,” said Elizabeth Seaquist, MD, Department of Medicine Chair at the U of M Medical School and endocrinologist with M Health Fairview. “This study provides evidence that clinicians can use in developing treatment plans with their patient.”
When compared to sitagliptin or glimepiride, patients receiving metformin plus liraglutide or insulin glargine reached and maintained their target blood levels for the longest period. When compared to sitagliptin, which was the least effective in sustaining target levels, this translated into nearly six months of extra time with blood glucose levels in the target range. Age, sex, race, or ethnicity had no impact on how well a treatment worked. None of the combinations, however, dramatically outperformed the others.
Launched in 2013, the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study was conducted at centers across the country, including the University of Minnesota. It was designed to compare four major medications approved by the Food and Drug Administration (FDA) at the time GRADE 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 to do next to best keep high blood glucose in check.
References: “Glycemia Reduction in Type 2 Diabetes — Glycemic Outcomes” by David M. Nathan, M.D., John M. Lachin, Sc.D., Ashok Balasubramanyam, M.D., Henry B. Burch, M.D., John B. Buse, M.D., Nicole M. Butera, Ph.D., Robert M. Cohen, M.D., Jill P. Crandall, M.D., Steven E. Kahn, M.B., Ch.B., Heidi Krause-Steinrauf, M.S., Mary E. Larkin, R.N., Neda Rasouli, M.D., Margaret Tiktin, D.N.P., Deborah J. Wexler, M.D. and Naji Younes, Ph.D., 22 September 2022, New England Journal of Medicine.
“Glycemia Reduction in Type 2 Diabetes — Microvascular and Cardiovascular Outcomes” by David M. Nathan, M.D., John M. Lachin, Sc.D., Ionut Bebu, Ph.D., Henry B. Burch, M.D., John B. Buse, M.D., Andrea L. Cherrington, M.D., Stephen P. Fortmann, M.D., Jennifer B. Green, M.D., Steven E. Kahn, M.B., Ch.B., M. Sue Kirkman, M.D., Heidi Krause-Steinrauf, M.S., Mary E. Larkin, R.N., Lawrence S. Phillips, M.D., Rodica Pop-Busui, M.D., Ph.D., Michael Steffes, M.D., Margaret Tiktin, D.N.P., Mark Tripputi, Ph.D., Deborah J. Wexler, M.D. and Naji Younes, Ph.D., 22 September 2022, New England Journal of Medicine.
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 Advancing 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 medications and supplies has been provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co., Inc., Novo Nordisk, Roche Diagnostics, and Sanofi.
ClinicalTrials.gov number: NCT01794143.