The UAB researchers said their data show that younger age and higher baseline HbA1c predict early treatment failure and that these patients require more aggressive initial treatment. It states that
University of Alabama at BirminghamDr. W. Timothy Garvey, Dr. Andrea Cherrington Researchers recently completed an NIH-funded study on differences in medication acceptability, quality of life, insulin secretion, mortality, and other outcomes among four commonly used type 2 diabetes drugs. The results were announced.
The Glycemic Lowering Approaches in Diabetes: Comparative Effectiveness (GRADE) study was conducted from 2013 to 2021 at 36 centers and nine subcenters in the United States. This study was designed to compare the combination of metformin with the four main drugs approved by the FDA to treat diabetes. Usual first-line drug. The findings of a major study focusing on relative differences in blood sugar (blood sugar) levels and the occurrence of cardiovascular diseases such as heart attacks and strokes will be published in the New England Journal of Medicine in September 2022. Published in two papers.
Ten scientific papers published in the April issue of Diabetes Care report other important differences between four drugs commonly used to treat type 2 diabetes. The GRADE study included more than 5,000 volunteer participants with type 2 diabetes from a variety of racial and ethnic groups. They were studied over a 5-year period, during which time insulin glargine, liraglutide, glimepiride, and sitagliptin were compared. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.
Diabetes affects more than 1 in 10 Americans, or more than 38 million people. People with diabetes who maintain their blood sugar levels in a near normal range generally have a much lower risk of developing diabetic complications, such as heart, kidney, and eye disease. The challenge is that most people with diabetes require multiple medications to control blood sugar levels over the long term.
Beyond the differences in glycemic control between four diabetes medications shown in previous publications, the results of the current study investigated individual characteristics associated with decreases and increases in average blood glucose levels over time. . For example, the main reasons for not maintaining good glycemic control are younger age and higher baseline blood sugar levels. Understanding these factors can help identify those who would benefit from more aggressive diabetes management. Another series of analyzes found that adding liraglutide to metformin improved quality of life 1 year after starting treatment, but that this benefit disappeared after that time. Improvements with liraglutide were related to the degree of weight loss, especially among those who were the highest at baseline.
Andrea Cherrington, MD, interim director of the Division of Preventive Medicine, and W. Timothy Garvey, MD, professor in the Department of Nutritional Sciences and director of the NIH-funded UAB Diabetes Research Center, served as co-principal investigators for GRADE. At UAB.
“HbA1c continued to increase over time in all four diabetes drug treatment groups, regardless of baseline characteristics,” Garvey said. “Therefore, we need better drugs that can maintain diabetes control for longer periods of time and slow progression to the point where insulin is required. None of the interventions in the GRADE study emphasized weight loss; , a new obesity drug also under study at UAB, may benefit a large proportion of patients with both diabetes and obesity in this regard.
Of note, assignment to insulin therapy was well accepted by participants, with even better compliance than other medications, and there was no negative impact of insulin therapy on participants’ diabetes-related distress. In fact, treatment with insulin and another injectable drug, liraglutide, reduced the suffering associated with diabetes. These findings largely debunk the myth that patients cannot tolerate insulin therapy or that their quality of life deteriorates once they begin insulin therapy.
Sensitivity to insulin action and insulin secretion from pancreatic beta cells is known to be an important cause of type 2 diabetes. The roles of each are reported in separate papers. Loss of insulin secretion was critically associated with progressive deterioration of glycemic control with all four drugs, and decreased insulin sensitivity contributed to treatment outcome.
The two most common causes of death during the study period were cardiovascular disease and cancer, which did not differ among the four treatment groups.
“GRADE has historically shown which drugs are most effective at achieving and maintaining blood glucose goals over time,” said David M. Nathan, MD, GRADE study chair and director of the Diabetes Center at Massachusetts General Hospital. . “The current findings provide additional information about the relative benefits and risks of drugs and should help patients and their health care providers choose the best drug to treat diabetes.”
The GRADE study was supported by grant U01DK098246 from NIDDK. Additional support was provided by the NIH’s National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, and National Center for the Advancement of Translational Sciences. 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 medicine and supplies is being provided by Becton Dickinson & Company, Bristol-Myers Squibb, Merck & Co., Novo Nordisk, Roche Diagnostics, and Sanofi. ClinicalTrials.gov number: NCT01794143.
