Comparing the effectiveness of 4 classes of medication used to manage diabetes mellitus type 2
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on September 23rd, 2022
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According to a clinical guideline published by the Vietnamese ministry of health, metformin, sulfonylurea, dipeptidyl peptidase 4 inhibitor, glucagon-like peptide-1 receptor agonist, and insulin are recommended to manage diabetes mellitus type 2. Each medication has its own contraindication, but little information was provided about the effectiveness of each class of drug. A recent paper published by the collaborative multi-center GRADE Study Research Group had reported that some of the recommended medications are more effective than others in managing diabetes mellitus type 2 (DM2).
The study included 5,047 participants who have been suffering from DM2 for the median duration of 4.2 ± 2.7 years with a glycated hemoglobin (Hb1Ac) level between 6.8% and 8.5%. Most of the patients (92.3%) are taking more than 2,000 mg of metformin per day - average daily dose is 1,944 ± 205 mg. The patients was randomly assigned to received one of the following treatment schemes:
The study found that, between the 4 agents being compared, glargine and liraglutide is the most effective in helping patients maintain a glycated hemoglobin level below 7.0%. Glimepiride is less effective than the insulin and GLP-1 RA, but it is still more effective than sitagliptin - the least effective of the four classes of drug. In terms of safety, the frequency of reported adverse events are very similar between the 4 groups. Severe hypoglycemia is not very common (0.7% to 1.3%), but those who received glimepiride are at a statistically significant higher risk (2.2%) than the other treatments. Those who received liraglutide experience a higher rate of gastrointestinal problem (43.7%) than the other three groups (33.7% to 35.7%). Besides managing Hb1Ac level, the liraglutide and sitagliptin groups experience more weight loss than the other two medications.
The study noted that they intentionally did not include thiazolidinediones and the sodium–glucose cotransporter 2 (SGLT2) inhibitor class of glucose-lowering medications to the study because the former has been associated with an increased risk of bone loss, and bladder cancer. In addition, SGLT-2 inhibitors were excluded because they were not approved by the Food and Drug Administration (FDA) for usage in the United States by the beginning of the study.
The study included 5,047 participants who have been suffering from DM2 for the median duration of 4.2 ± 2.7 years with a glycated hemoglobin (Hb1Ac) level between 6.8% and 8.5%. Most of the patients (92.3%) are taking more than 2,000 mg of metformin per day - average daily dose is 1,944 ± 205 mg. The patients was randomly assigned to received one of the following treatment schemes:
- Daily subcutaneous injection of insulin in the form of glargine U-100 with an maximum dose of 20 U
- Daily oral intake of glimepiride, a sulfonylurea agent (SU), initially at 1-2 mg to a maximum of 8 mg
- Daily oral intake of liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), initially at 0.6 mg to a maximum of 1.8 mg
- Daily oral intake of sitagliptin, a dipeptidyl peptidase 4 inhibitor (DDP-4I), at a maximum dose of 100 mg
The study found that, between the 4 agents being compared, glargine and liraglutide is the most effective in helping patients maintain a glycated hemoglobin level below 7.0%. Glimepiride is less effective than the insulin and GLP-1 RA, but it is still more effective than sitagliptin - the least effective of the four classes of drug. In terms of safety, the frequency of reported adverse events are very similar between the 4 groups. Severe hypoglycemia is not very common (0.7% to 1.3%), but those who received glimepiride are at a statistically significant higher risk (2.2%) than the other treatments. Those who received liraglutide experience a higher rate of gastrointestinal problem (43.7%) than the other three groups (33.7% to 35.7%). Besides managing Hb1Ac level, the liraglutide and sitagliptin groups experience more weight loss than the other two medications.
The study noted that they intentionally did not include thiazolidinediones and the sodium–glucose cotransporter 2 (SGLT2) inhibitor class of glucose-lowering medications to the study because the former has been associated with an increased risk of bone loss, and bladder cancer. In addition, SGLT-2 inhibitors were excluded because they were not approved by the Food and Drug Administration (FDA) for usage in the United States by the beginning of the study.