THURSDAY, Sept. 22, 2022 (HealthDay News) — Two common diabetes medications appear to be superior to the other two when it comes to controlling blood sugar, a large U.S. study has found.

Court proceedings More than 5,000 people with type 2 diabetes found that two injectable drugs, long-acting insulin and liraglutide (Victoza) – usually works better than the two oral medications for maintaining blood sugar.

Over five years, patients receiving the injection treatment spent more time with their blood sugar in the recommended range—an average of six extra months.

However, most patients have not been able to achieve this goal for a long time. Experts say this highlights how difficult the task is for people with diabetes.

“Ultimately, treatment combinations did not maintain optimal A1C levels in many patients for long-term treatment of type 2 diabetes,” said researcher Dr. Henry Burch of the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

A1C is an indicator of the average level of sugar in a person’s blood over the past three months. If people have diabetes, the goal is to keep their A1C below 7%.

In the study, 71% of patients failed to reach this goal during the five-year follow-up.

More than 37 million Americans have diabetes, the vast majority of whom type 2, according to the NIDDK. In this form of the disease, the body loses its ability to properly use insulin, the hormone that moves sugar from food into the body’s cells for energy.

As a result, sugar builds up in the blood, which over time can damage blood vessels and nerves. Many people with diabetes develop complications such as heart disease, kidney failure, nerve damage in the feet and legs, and potential eye disease.

Controlling your blood sugar is key to reducing these risks. Most people with type 2 diabetes take oral medications to do this metforminalong with dietary changes and exercise.

New findings – published on September 22 in New England Journal of Medicine – come from trials started nearly a decade ago and funded by the NIDDK. The goal was to determine which diabetes medications, when added to metformin, are most effective in helping patients maintain their recommended A1C target.

Just over 5,000 US adults with type 2 diabetes were randomly assigned to add one of four treatments: insulin glargine (Lantus), a long-acting synthetic insulin; liraglutide; glimepiride (Amaryl), which belongs to a class of drugs called sulfonylureas; or sitagliptin (Januvia), a DPP-4 inhibitor.

Over five years, patients taking insulin or liraglutide were most successful in maintaining their A1C levels at target. About 67% saw their blood sugar exceed this target at some point, compared with 72% of glimepiride patients and 77% of sitagliptin patients.

On average, patients who received the injectable treatment had about six additional months in the target range compared to the sitagliptin group.

Patients taking all treatments tended to lose or maintain weight, but the weight loss was greatest with liraglutide, which helped people lose an average of 7 pounds. (Another formulation of the drug, sold as Saxenda, is approved as a weight-loss aid.)

Overall, however, no treatment was a home run.

An “important takeaway” from the trials, Burch said, is that if people aren’t reaching their A1C goal, they and their doctors should be open to switching or adding medications, as well as making healthy lifestyle changes.

According to a diabetes expert who was not involved in the trial, there is no one-size-fits-all strategy.

In the years since the study began, guidelines have placed greater emphasis on the importance of individualized treatment, said Dr. Roland J. W. Middlebeck of the Joslin Diabetes Center in Boston.

For any given patient, he said, there are several factors to consider when choosing a medication — including co-existing conditions such as heart or kidney disease, whether the goal is weight control and the cost of the medication.

So it’s important for patients, Midelbeck said, to work one-on-one with their doctor to figure out the best treatment plan.

Researchers note that other changes have occurred since the trial, which began in 2013. A new class of diabetes drugs called SGLT2 inhibitors is now available. These include medications such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).

And in the past few years, guidelines have emerged supporting SGLT2 inhibitors and GLP-1 receptor agonists (including liraglutide) as preferred options for patients with heart or kidney disease.

But managing diabetes and preventing its complications requires more than blood sugar control. Burch said it’s also very important to keep high blood pressure and high cholesterol in check, quit smoking and aim for a healthier weight.

Additional information

The US National Institute of Diabetes and Digestive and Kidney Diseases has an overview type 2 diabetes.

SOURCES: Henry Burch, MD, program director, Division of Diabetes, Endocrinology, and Metabolic Diseases, US National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; Roeland JW Middelbeek, MD, staff physician, assistant investigator, Joslin Diabetes Center, and instructor, Harvard Medical School, Boston; New England Journal of MedicineSeptember 22, 2022

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