NIH releases study on diabetes medications

An NIH-backed study reported in 2 papers in the New England Journal of Medicine shows that the diabetes treatments insulin glargine and liraglutide more effectively maintain target blood sugar levels than sitagliptin or glimepiride when added to first-line metformin.

Clinicians typically prescribe metformin, along with exercise and diet modifications, as initial treatment for diabetes, but it is generally understood that more than one medication will be needed over time.

What the best options are for long-term diabetes management have yet to be determined. The randomized GRADE trial dug into this question by examining 4 common interventions and their effects in an ethnically and racially diverse population of more than 5,000 patients with type 2 diabetes.

Liraglutide or insulin glargine plus metformin kept blood sugar levels within range for the longest period. However, almost 75% of study participants overall failed to stay on target over 4 years.

“GRADE effectively shows which drugs worked best at achieving and maintaining blood glucose targets over time, but we need to establish even more effective strategies for the long-term maintenance of acceptable glucose levels,” said study chair David M. Nathan, director of the Massachusetts General Hospital Diabetes Center. “We still have more work to do, such as evaluating other interventions and treatment combinations to help people with type 2 diabetes achieve long-term glucose control.”

A new class of drugs called SGLT-2 inhibitors that are now available were excluded from the GRADE study because they were not FDA-approved in 2013, when the clinical trial was launched.