In a head-to-head comparison of four drugs used to treat type 2 diabetes, Lantus (insulin glargine) and Victoza (liraglutide) edged out the competition — but all four drugs were found to be safe and effective, according to a new study published in the New England Journal of Medicine.
Studies that compare different diabetes treatments should not be viewed as evidence that certain drugs are always more effective than others — especially when it comes to type 2 diabetes, there are a variety of factors unique to each person that may determine what treatment works best. It’s also worth noting that while blood glucose control is usually the main outcome of concern when evaluating diabetes treatments, it’s not the only outcome that matters. Weight gain or weight loss, the ability to tolerate drugs without unpleasant or dangerous side effects, and additional health benefits like improved kidney function or a lower risk of dying may all be worthy considerations when deciding on a treatment plan.
For the latest study, researchers recruited 5,047 adult participants with type 2 diabetes — diagnosed less than 10 years earlier — who were taking metformin as their only glucose-lowering drug. Participants were randomly assigned to take an additional diabetes drug — either Lantus, Victoza, Januvia (sitagliptin), or glimepiride. Participants had their A1C level (a measure of long-term blood glucose control) measured quarterly, and were followed for an average of five years.
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Differences in A1C levels between treatments
When the researchers looked at how often participants in each drug treatment group had an A1C level of 7.0% or higher — indicating less-than-optimal blood glucose control — there were significant differences between the groups. For Lantus, the rate of A1C levels this high was 26.5 per 100 person-years (years of follow-up among participants), and for Victoza it was similar at 26.1 per 100 person-years. For glimepiride, the rate of A1C levels this high was 30.4 per 100 person-years, while for Januvia it was 38.1 per 100 person-years. When the researchers looked at how often participants had an A1C level of 7.5% or higher, the differences between the drug groups were similar to what was seen for 7.0%.
There were no significant differences in A1C measurements between the different drug groups based on participants’ age, sex, race, or ethnicity. But for participants who began the study with a higher A1C level, a greater A1C-lowering benefit was seen in the Lantus, Victoza, and glimepiride groups compared with the Januvia group.
Severe hypoglycemia (low blood glucose) was rare in general, but was more common with some of the drugs than others — the proportion of participants who experienced this serious condition was 2.2% for glimepiride, 1.3% for Lantus, 1.0% for Victoza, and 0.7% for Januvia. Gastrointestinal side effects and weight loss were both more common among participants who took Victoza than in the other groups.
The researchers concluded that Lantus and Victoza “were significantly, albeit modestly, more effective in achieving and maintaining target [A1C] levels.” These results may inform what drugs doctors consider prescribing when metformin is no longer enough to maintain adequate blood glucose control in people with type 2 diabetes.
Want to learn more about blood glucose management? See our “Blood Sugar Chart,” then read “Blood Sugar Monitoring: When to Check and Why” and “Strike the Spike II: How to Manage High Blood Glucose After Meals.”