Which is the best medication for people with diabetes? A new study has looked at several diabetes drugs and found which ones are the best.
The study, presented Monday at the virtual annual meeting of the American Diabetes Association, has found that (insulin glargine) and Victoza (liraglutide) are better at managing diabetes over time than Amaryl (glimepiride) or Januvia (sitagliptin), according to Medicine Net.
Dr. Steven Kahn, a member of the executive committee that oversaw the study, said, “We’ve known that type 2 diabetes is a progressive disease, and these medications, in general, do not reduce or obliterate progression and that the ability of these medications to slow the rise in glucose varies amongst them.”
“When we look at the rise in A1C over time, it’s clear that there are initial beneficial impacts of one drug over the other, but they tend to fail at a very similar rate,” explained Dr. Kahn, who is a professor of medicine, metabolism, endocrinology, and nutrition at the University of Washington in Seattle.
So, beyond the first couple of years, all the failure seems to be occurring at the same rate, but overall failure was less with Lantus and Victoza,” he added.
Lantus and Victoza are injectable drugs, while Amaryl and Januvia come in the form of oral pills.
The researchers found that both Lantus and Victoza were the most effective drugs in keeping HbA1C levels under 7. However, Amaryl and Januvia had the lowest effect and increased HbA1C levels above 7.
Dr. Caroline Messer of Lenox Hill Hospital in New York City said the study confirms that these medications are appropriate and should be used as a second-line treatment after metformin (Glucophage), or as a first-line treatment if metformin is not tolerated, per Medicine Net.
“I think the only disservice of 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 that it does a disservice because if people are reaching for insulin too quickly because of this trial, that would be a shame.”
However, Dr. Joel Zonszein of Albert Einstein College of Medicine in New York City thinks the study is outdated.
He said, “It certainly proves that Victoza and Lantus are better medications to improve blood sugar control when metformin is not enough,” adding that the study did not include other diabetes drugs approved by the Food and Drug Administration (FDA) when the study began. So, he said, there could be more effective drug combinations that are yet to be tested.
“We need to know what the best combination is for treatment of diabetes early in the disease and not to use the antiquated step-up approach — what to do when the medication fails?” Dr. Zonsein said. “We have an excellent choice of medications, and there is no reason to have individuals with diabetes not well-treated.”
Dr. Kahn said he prefers individualized treatment for type 2 diabetes. He wishes that pharma companies would do head-to-head clinical trials of the newer drugs to determine the best combinational treatment for diabetes.