Current 25 - Four Drugs Found Beneficial for Glycemic Reduction in Patients with Type 2 Diabetes

Summary

In the recent Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), all four drugs compared (insulin glargine, glimepiride, liraglutide, and sitagliptin) had a beneficial effect on glycemic reduction.¹ Glargine and liraglutide performed best, both in achieving and sustaining glycemic outcomes. Of note, severe hypoglycemia was more common in the glimepiride (2.2%) and insulin (1.3%) groups; liraglutide was associated with more weight loss.

In the trial, approximately 5,000 patients with type 2 diabetes (duration < 10 years, baseline A1C: 6.8% to 8.5%) on metformin monotherapy were randomized to the four drugs and followed for 5 years. The primary outcome was A1C of 7%; secondary outcomes included A1C of 7.5% and the development of micro- and macrovascular complications.²

The GRADE study provides key evidence to support the next treatment step for patients with type 2 diabetes, without cardiovascular or renal disease, who are already on metformin.¹ These results serve as a basis for shared decision making when glycemic goals are not reached with metformin alone.³

Sources

¹GRADE Study Research Group, Nathan DM, Lachin JM, Balasubramanyam A, et al. Glycemia reduction in type 2 diabetes — glycemic outcomes. N Engl J Med. 2022;387(12):1063-74. doi:10.1056/NEJMoa2200433.

²GRADE Study Research Group, Nathan DM, Lachin JM, Buse JB, et al. Glycemia reduction in type 2 diabetes — microvascular and cardiovascular outcomes. N Engl J Med. 2022;387(12):1075-1088. doi:10.1056/NEJMoa2200436.

³Rydén L, Standl E. After metformin — next steps for type 2 diabetes with low cardiovascular risk. N Engl J Med. 2022;387(12):1136-1138. doi:10.1056/NEJMe2210531.