Glucose-Lowering Meds Compared for Use With Metformin in T2DM

MONDAY, Oct. 3, 2022 (HealthDay News) -- For patients with type 2 diabetes receiving metformin, the addition of glargine and liraglutide is more effective than glimepiride and sitagliptin for achieving and maintaining target glycated hemoglobin levels, while the incidence of microvascular complications and deaths do not differ materially between the groups, according to two studies published in the Sept. 22 issue of the New England Journal of Medicine.

David M. Nathan, M.D., from Harvard Medical School in Boston, and colleagues compared the effectiveness of insulin glargine U-100, glimepiride, liraglutide, or sitagliptin in a randomized trial involving 5,047 participants with type 2 diabetes of less than 10 years' duration who were receiving metformin. The researchers found that the cumulative incidence of a glycated hemoglobin level of 7.0 percent or higher differed significantly between the groups, with similarly lower rates for glargine and liraglutide (26.5 and 26.1 per 100 participant-years, respectively) versus glimepiride and sitagliptin (30.4 and 38.1 per 100 participant-years, respectively). Parallel differences were seen with respect to a glycated hemoglobin level greater than 7.5 percent.

In a second study, Nathan and colleagues examined the microvascular and cardiovascular disease outcomes in the same cohort of patients. The researchers observed no material differences among the interventions with respect to the development of hypertension or dyslipidemia or with respect to microvascular outcomes. There was no difference seen in the treatment groups with respect to major adverse cardiovascular events, and only small differences were seen with respect to rates of any cardiovascular disease.

"The data confirm that older generic or biosimilar low-cost agents still have a role in the treatment of persons with early type 2 diabetes who are at low cardiovascular risk," write the authors of an accompanying editorial.

Becton Dickinson, Bristol Myers Squibb, Merck, Novo Nordisk, Roche Diagnostics, and Sanofi donated medications and supplies.

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Editorial (subscription or payment may be required)