By Steven Reinberg
HealthDay reporter
TUESDAY, June 29, 2021 (HealthDay News) – You have type 2 diabetes and are already taking an old standby drug, metformin. But you still need help controlling your blood sugar levels. Which drug would be best?
New research juxtaposed several diabetes drugs and came up with an answer: The diabetes drugs Lantus and Victoza were able to control blood sugar better over time than Amaryl or Januvia.
“We know that type 2 diabetes is a progressive disease and these drugs generally do not reduce or erase progression, and that the ability of these drugs to slow the rise in glucose varies between them,” said Dr. Steven Kahn, Professor of Medicine, Metabolism, Endocrinology and Nutrition at the University of Washington in Seattle. He is a member of the executive committee that oversaw the process.
The aim was to find out which of these drugs kept the average blood sugar level in the recommended target range at an A1C value of less than 7%. A1C blood tests are a standard way to measure long-term blood sugar control.
“If we look at the increase in A1C over time, it’s clear that there are initial positive effects of one drug on the other, but they tend to fail at a very similar rate,” said Kahn. “After the first few years, all failures seem to be occurring at the same rate, but the overall failure rates were lower for Lantus and Victoza.”
Lantus (insulin glargine) and Victoza (liraglutide) are both injectable drugs, while Amaryl (glimepiride) and Januvia (sitagliptin) are pills.
The study, which was funded by the US National Institutes of Health, enrolled more than 5,000 people with type 2 diabetes, a mean age of 57 years. Participants, 20% of whom were Black and 18% Hispanic American, were randomly selected to take one of the four drugs along with metformin in the study, which ran 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 were the least effective and more likely to get A1C levels above 7%.
The results were similar by gender, race, ethnicity, and age group.
Further findings were:
- Patients taking Victoza and Januvia were more likely to lose weight than those taking Amaryl. Those who took 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 the other drugs.
- Victoza was associated with a lower risk of heart attack, stroke, and other cardiovascular complications than the other drugs.
Dr. Caroline Messer, an endocrinologist at Lenox Hill Hospital in New York City, said the study confirms that these drugs are appropriate and should be used as second-line treatment after metformin or as first-line treatment when metformin is not tolerated.
Messer found that some of the newer drugs, while expensive, are covered by most health insurance companies.
“I think the only downside to the study is that I don’t want people to start thinking that you should be using insulin.” [Lantus] as a second-line treatment, “she explained.” I think it does a disservice because if people were to reach for insulin too quickly based on this study, it would be a shame.
The results were presented at the American Diabetes Association’s annual virtual meeting on Monday. Results presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Dr. Joel Zonszein, professor emeritus of medicine at Albert Einstein College of Medicine in New York City, was not surprised by the results, but thinks the study is out of date.
“It certainly proves that Victoza and Lantus are better drugs for improving blood sugar control when metformin isn’t enough,” he said.
The problem with the study is that it didn’t include any other drugs that were approved by the U.S. Food and Drug Administration at the start of the study, so there may be more effective drug combinations that have yet to be tested, Zonszein said.
“We need to know which combination is the best combination for treating early-stage diabetes rather than the antiquated step-up approach – what to do if the drug fails? We have an excellent range of medicines and there is no reason for “not treating people with diabetes well,” he added.
And in treating diabetes, treating blood sugar isn’t the only consideration, Zonszein noted.
“We treat each patient and individualize the therapy accordingly. Treatment includes obesity, high cholesterol and high blood pressure, among others. We want to improve and prolong a good quality of life,” he said. “For example, the weight loss seen with Victoza is important to many and was not found with the other agents in the study. The gastrointestinal side effects of Victoza are also known and are reduced when newer weekly medications are used.”
Although blood sugar levels are important, treatment aims to avoid or delay the complications of diabetes, Zonszein said.
Since stroke and heart attack are the leading causes of death in diabetic patients, treatment should include drugs that prevent heart attack, stroke, and other cardiovascular complications, as well as kidney disease.
“The … process is therefore out of date and does not help people or their healthcare providers to make decisions in 2021 – the train has left the station,” said Zonszein.
“The treatment of diabetes has shifted towards individualized therapy that uses the right drugs from the start. We are now using drugs that don’t cause low blood sugar or require frequent blood sugar controls. Of course, we use drugs that help with weight loss and can cause fewer cardiovascular complications, “he explained.
Kahn said he was very much in favor of an individualized treatment for type 2 diabetes. He also wants drug companies to conduct head-to-head studies of the newer drugs to determine the best combination treatment.
More information
For more information on type 2 diabetes, visit the 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 Zonszein, MD, Professor Emeritus of Medicine, Albert Einstein College of Medicine, New York City; June 28, 2021, annual virtual meeting presentation, American Diabetes Association meeting
