Best blood sugar medicine for type 2 diabetes


Written by Stephen Rheinberg
HealthDay reporter

Tuesday, June 29, 2021 (HealthDay News) – You have Type 2 diabetesand you are already taking an old backup drug, metformin. But you still need help controlling files blood sugar levels. Which drug would be the best?

New research incited several diabetic Drugs against each other and they came up with an answer: diabetes drugs Lantus And the victoza were better at controlling blood sugar over time amaryl or Januvia.

“We’ve learned that type 2 diabetes is a progressive disease, and these medications generally do not reduce or erase progression, and that the ability of these medications to slow the rise in glucose varies among themselves,” Dr. Stephen explained. Kahn, professor of medicine, Metabolismendocrine and feed at the University of Washington in Seattle. He is a member of the executive committee that oversaw the trial.

The goal was to find out which of these medications keeps average blood sugar levels in the recommended target range, when A1C . level less than 7%. A1C blood tests are a standard way to measure long-term blood sugar control.

“When we look at the rise in A1C over time, it’s clear that there are initial beneficial effects of one drug over the other, but they tend to fail at a very similar rate,” Khan said. “So after the first two years it seems like all failures happen at the same rate, but the overall failures were less with Lantus and Victoza.”

Lantus (insulin glargine) and Victoza (liraglutide) are both injectable medications, while Amaryl (glimepiride) and Januvia (sitagliptin) are pills.

The study, which was funded by the US National Institutes of Health, included more than 5,000 people with type 2 diabetes, with an average age of 57. The participants, who were 20% black and 18% Hispanic, randomly on one. Among the four drugs besides metformin in the trial, which lasted an average of four years.

The researchers found that Lantus and Victoza were most effective in keeping A1C levels below 7%, while Amaryl or Januvia had the least effect and the highest odds of letting A1C levels rise above 7%.

The results were similar across gender, race, ethnicity, and age group.

Other results included:

  • Patients treated with Victoza and Januvia were more likely to lose weight than those who took Amaryl. Those who took Lantus maintained a stable weight.
  • Victoza causes more gastrointestinal side effects, such as nausea, abdominal pain and diarrhea, than other medicines. Amaryl has been associated with a higher risk of low blood sugar compared to other medications.
  • Victoza has been linked to a lower risk of heart attack, stroke, and other cardiovascular complications than other medications.

Dr. Caroline Messer, Endocrinologist At Lenox Hill Hospital in New York City, the study confirms that these drugs are appropriate and should be used as second-line therapy after metformin, or as first-line therapy if metformin is not tolerated.

Messer noted that although some of the new drugs are expensive, they are covered by most health insurance plans.

“I think the only downside to the study is that I don’t want people to start thinking you should use insulin [Lantus] She explained it as a second-class treatment. I think it hurts, because if people were using insulin too quickly because of this experience, it would be a shame.

The findings were presented Monday at the American Diabetes Association’s virtual annual meeting. Results presented at medical meetings should be considered preliminary until they are published in a peer-reviewed journal.

Joel Zonszen, MD, professor of medicine emeritus at Albert Einstein College of Medicine in New York City, isn’t surprised by the results, but he thinks the experiment is outdated.

“It certainly proves that Victosa and Lantus are better drugs for improving glycemic control when metformin is not enough,” he said.

The problem with the study, Zonszein said, is that it didn’t include other FDA-approved drugs when the study began, so there may be more effective drug combinations that haven’t been tested yet.

“We need to know the best combination to treat diabetes early in the disease and not use an outdated bottom-up approach – what do we do when medication fails? We have an excellent selection of medications, and there is no reason why people with diabetes are not well treated.”

And when Diabetes managementZonszein noted that treating blood sugar is not the only consideration.

“We treat each patient and customize regimens accordingly. Treatment includes يشمل obesityAnd the high fat And the Hypertension, among other things. “We aim to improve and prolong a good quality of life,” he said. For example, the weight loss found with Victoza is important to many, and was not found with the other factors in the study. The gastrointestinal side effects of Victoza are also well known, and are lessened when newer weekly medications are used.”

Although blood sugar levels are important, treatment is aimed at avoiding or delaying complications of diabetes, Zonszein says.

Because brain attack And the Heart attack They are the common causes of death among people with diabetes, and treatment should include medications that prevent heart attack, stroke, and other cardiovascular complications, as well as kidney disease.

“The experience … is outdated, and doesn’t help people or healthcare providers make decisions in 2021 – the train has left the station,” Zonszein said.

“The treatment of diabetes has shifted towards individual therapy, using the right medicines from the start. We now use medicines that do not cause low blood sugar Or you need frequent blood sugar checks. Certainly, we use medications that can help with weight loss and reduce cardiovascular complications.”

Kahn said all are receiving individual treatment for type 2 diabetes. He also hopes drug companies will conduct direct trials of newer drugs to determine the best combination treatment.

more information

To learn more about type 2 diabetes, head over to American Diabetes Association.

SOURCES: Stephen Kahn, MD, Professor of Medicine, Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle; Caroline Messer, MD, endocrinologist, Lenox Hill Hospital, New York City; Joel Zonszen, MD, Emeritus Professor, Medicine, Albert Einstein College of Medicine, New York City; June 28, 2021 virtual annual meeting presentation, American Diabetes Association meeting


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