University of Alabama at Birmingham researchers recently presented NIH-funded findings regarding differences in medication acceptance, quality of life, insulin secretion, mortality and other outcomes among four commonly used Type 2 diabetes medications.
The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study was conducted at 36 United States centers and nine subsites between 2013 and 2021. It was designed to compare four major medications approved by the FDA to treat diabetes in combination with metformin, the usual first-line drug. Major results focusing on the relative differences in blood glucose, or sugar, levels and the occurrence of cardiovascular outcomes, like heart attacks and stroke, were published in two papers in The New England Journal of Medicine in September 2022.
Ten scientific papers published in the April issue of Diabetes Care report other important differences between the four medications that are commonly used to treat Type 2 diabetes. The GRADE Study included more than 5,000 volunteer participants with Type 2 diabetes from diverse racial and ethnic groups. They were studied over five years, during which insulin glargine, liraglutide, glimepiride and sitagliptin were compared. The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.
Diabetes affects more than one in 10 — or more than 38 million — Americans. People with diabetes who keep their blood sugar levels in the near-normal range generally have a much lower risk of developing diabetes complications such as heart, kidney and eye diseases. The challenge is that most people with diabetes require more than one medication to control blood sugar levels over time.
Beyond the differences in blood sugar control between the four diabetes medications shown in the previous publications, the current findings examined individual characteristics that were associated with the achievement of lower and higher average blood sugar levels over time. For example, the inability to maintain good blood sugar control was largely driven by younger age and higher blood sugar levels at baseline. Understanding these factors can help to identify people who would benefit from more aggressive diabetes management. Another set of analyses revealed that adding liraglutide to metformin improved quality of life after the first year of treatment, but this benefit was subsequently lost. The improvement with liraglutide was related to the degree of weight loss, particularly in those who had the highest weight at baseline.
Andrea Cherrington, M.D., interim director of the Division of Preventive Medicine, and W. Timothy Garvey, M.D., professor in the Department of Nutrition Sciences and director of the NIH-funded UAB Diabetes Research Center, served as the co-principal investigators of GRADE at UAB.