At a Glance –
A comparison of four common drugs for treating type 2 diabetes showed that two outperformed the others in maintaining target blood sugar levels. The findings offer new insights for the long-term management of type 2 diabetes.
Diabetes affects more than 37 million Americans. Up to about 95% of them have type 2 diabetes, in which their body doesn’t make or use insulin well. This can impair the ability to keep levels of blood sugar (also called blood glucose) in a safe range. When blood glucose gets too high, it can cause complications such as nerve, kidney, eye, and heart-related conditions.
- A drug called metformin has long been the considered the first-line medication for type 2 diabetes.
- Health care professionals generally recommend metformin combined with diet and exercise as the best early approach to diabetes care.
- If blood glucose becomes difficult to control over time, a second medication is often added.
But there had been no consensus regarding which medications might best be added to metformin to keep blood glucose levels in check. And it had been unclear which drugs might best protect against common side effects, such as cardiovascular disease. To find answers, NIH supported a large clinical trial to directly compare four drugs often used in combination with metformin to treat type 2 diabetes.
- The trial was conducted at 36 study centers nationwide.
- Findings were described in a pair of papers that appeared in the New England Journal of Medicine on September 22, 2022.
- The trial enrolled more than 5,000 people with type 2 diabetes who were already taking metformin.
- They were from diverse racial and ethnic backgrounds.
Participants were randomly placed into one of four treatment groups. Three groups took metformin plus a medicine that increased insulin levels: sitagliptin, liraglutide, or glimepiride. The fourth group took metformin and insulin glargine U-100, a long-acting insulin.
After about five years of follow-up, the researchers found that all four drugs improved blood glucose levels when added to metformin. But those taking metformin plus liraglutide or the long-acting insulin achieved and maintained their target blood levels for the longest time. They had about six months more time with blood glucose levels in the target range compared with those taking sitagliptin, the least effective in maintaining target levels.
The effects of treatment did not differ with age, sex, race, or ethnicity. However, none of the combinations overwhelmingly outperformed the others. Although average blood sugar levels decreased during the study, nearly three of four participants were unable to maintain the blood glucose target over the study period.
This underscores the difficulty for many patients with type 2 diabetes to maintain recommended targets. The study also looked at the drugs’ effects on developing diabetes-related cardiovascular disease and other conditions. Although the differences were small, participants in the liraglutide group were least likely to experience any cardiovascular disease.
However, gastrointestinal symptoms were more common with liraglutide than with the other groups. Severe hypoglycemia, or low blood glucose, was generally uncommon, but affected more participants assigned to glimepiride. “This study was designed to provide health care providers with important information on how to guide the long-term management of type 2 diabetes,” says the study’s project scientist, Dr.
What is the best pill for type 2 diabetes?
Diabetes medications – If you can’t maintain your target blood sugar level with diet and exercise, your doctor may prescribe diabetes medications that help lower insulin levels or insulin therapy. Drug treatments for type 2 diabetes include the following.
Metformin (Fortamet, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. It works primarily by lowering glucose production in the liver and improving your body’s sensitivity to insulin so that your body uses insulin more effectively. Some people experience B-12 deficiency and may need to take supplements.
Other possible side effects, which may improve over time, include:
Nausea Abdominal pain Bloating Diarrhea
Sulfonylureas help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include:
Low blood sugar Weight gain
Glinides stimulate the pancreas to secrete more insulin. They’re faster acting than sulfonylureas, and the duration of their effect in the body is shorter. Examples include repaglinide and nateglinide. Possible side effects include:
Low blood sugar Weight gain
Thiazolidinediones make the body’s tissues more sensitive to insulin. Examples include rosiglitazone (Avandia) and pioglitazone (Actos). Possible side effects include:
Risk of congestive heart failure Risk of bladder cancer (pioglitazone) Risk of bone fractures High cholesterol (rosiglitazone) Weight gain
DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). Possible side effects include:
Risk of pancreatitis Joint pain
GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide (Byetta, Bydureon), liraglutide (Saxenda, Victoza) and semaglutide (Rybelsus, Ozempic). Possible side effects include:
Risk of pancreatitis Nausea Vomiting Diarrhea
SGLT2 inhibitors affect the blood-filtering functions in your kidneys by inhibiting the return of glucose to the bloodstream. As a result, glucose is excreted in the urine. These drugs may reduce the risk of heart attack and stroke in people with a high risk of those conditions.
Risk of amputation (canagliflozin) Risk of bone fractures (canagliflozin) Risk of gangrene Vaginal yeast infections Urinary tract infections Low blood pressure High cholesterol
Other medications your doctor might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering medications, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
What is the best diabetic medicine you can take?
Most diabetes medications effectively lower blood sugar – The blood sugar goal for most adults with diabetes is an A1C of below 7%. (A1C is a measure of a person’s average blood sugar over a period of about three months.) In many people, diet and exercise are not enough to reach this goal, and one or more medications may be needed.
- Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy.
- It is affordable, safe, effective, and well tolerated by most people.
- When metformin does not adequately control blood sugar, another medication must be added.
It is at this point that doctors and patients must choose among the many drugs and drugs classes available to treat type 2 diabetes. In general, for people who are at low risk of heart disease or have no history of diabetic kidney disease, most diabetes medications that are added to metformin effectively reduce blood sugars and can lower A1C to under 7%.
Is there something better than metformin for type 2 diabetes?
Insulin remains the most effective therapy to lower glucose, particularly in comparison to most oral medicines for type 2 (including metformin).
How can I quickly lower my blood sugar?
We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process. Healthline only shows you brands and products that we stand behind. Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:
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We do the research so you can find trusted products for your health and wellness. The quickest way to lower your blood sugar is to take fast-acting insulin. Exercising is another fast, effective way. In some cases, you should go to the hospital. High blood sugar levels are known as hyperglycemia or high blood glucose.
shortness of breathbreath that smells fruitynausea and vomitinga very dry mouth
If you aren’t sure what to do, call your doctor to get instructions on administering a dose of insulin, and for advice about whether to go to the emergency room. This article looks at ways to lower your blood sugar quickly, when to go to the emergency room or see a doctor, and tips for managing high blood sugar.
What is a safer drug than metformin?
Metformin doesn’t work for everyone. Precose, Januvia, Victoza, Glucotrol XL, and Actos are some metformin alternatives. Get the full list here. Comparison | Precose | Januvia | Victoza | Glucotrol XL | Actos | Natural alternatives | How to switch meds Metformin is an oral prescription medication used in the treatment of Type 2 diabetes mellitus,
It belongs to a class of drugs known as biguanides, Diabetes mellitus affects approximately 34 million people, a significant portion of the American population. It is estimated that another 88 million have prediabetes, Diabetics are likely to have other comorbid conditions such as high blood pressure, high cholesterol, and heart disease,
There are two types of diabetes, Type 1 and Type 2, Type 2 diabetics have a variety of oral and injectable medications available to treat their hyperglycemia. Long term control of blood sugar is typically measured by a serum lab value known as hemoglobin A1C (HbA1C).
- Metformin is a first-line treatment for Type 2 diabetes management,
- It is a generally safe, effective, and cost-conscious choice.
- Metformin works to decrease blood glucose levels by decreasing glucose production by the liver, decreasing glucose absorption in the intestine, and increasing the utilization of glucose in skeletal muscle and adipose tissue.
It rarely causes hypoglycemia, or dangerously low blood sugar, Metformin is also used in patients with polycystic ovary syndrome to treat the condition’s associated insulin resistance, Unfortunately, not everyone will be a candidate for metformin therapy.
- Patients with a history of a hypersensitive reaction to metformin or any biguanide can not take metformin,
- Patients with severe renal impairment also should avoid metformin therapy.
- For some, the gastrointestinal side effects of metformin are more than they can manage, and they will struggle to be compliant with metformin,
While taking the extended-release version of metformin may alleviate some of the GI-associated factors, it may not be enough for a patient to take metformin regularly as prescribed.
What pill is better than metformin?
Best Blood Sugar Meds for Type 2 Diabetes By Steven Reinberg HealthDay Reporter TUESDAY, June 29, 2021 (HealthDay News) – You have type 2 diabetes, and you are already taking an old standby drug, metformin. But you still need help controlling your blood sugar levels.
Which medication would be the best? New research pitted several diabetes drugs against each other and came up with an answer: The diabetes drugs Lantus and Victoza were better at controlling blood sugar over time than Amaryl or Januvia. “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,” explained Dr.
Steven Kahn, a professor of medicine, metabolism, endocrinology and nutrition at the University of Washington in Seattle. He is a member of the executive committee that oversaw the trial. The goal was to see which of these drugs kept average blood sugar levels in the recommended target range, at an A1C level of less than 7%.
A1C blood tests are a standard means of gauging long-term blood sugar control. “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,” Kahn said. “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.” Lantus (insulin glargine) and Victoza (liraglutide) are both injectable drugs, while Amaryl (glimepiride) and Januvia (sitagliptin) are pills.
The study, which was funded by the U.S. National Institutes of Health, included more than 5,000 people with type 2 diabetes, average age 57. The participants, 20% of whom were Black and 18% of whom were Hispanic, were randomly assigned to one of the four drugs along with metformin in the trial, which ran an average of four years.
Patients given Victoza and Januvia were more likely to lose weight than those taking Amaryl. Those taking Lantus maintained a stable weight.Victoza caused more gastrointestinal side effects, such as nausea, abdominal pain and diarrhea, than the other drugs. Amaryl was linked to a higher risk for low blood sugar than the other drugs.Victoza was linked to a lower risk of heart attack, stroke and other heart and vascular complications than the other drugs.
Dr. Caroline Messer, an endocrinologist at 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, or as a first-line treatment if metformin isn’t tolerated.
Messer noted that although some of the newer drugs are expensive, they are covered by most health insurance plans. “I think the only disservice of the study is that I don’t want people to start thinking that you should be using insulin 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.” The findings were presented Monday at the virtual annual meeting of the American Diabetes Association.
Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal. Dr. Joel Zonszein, an emeritus professor of medicine at Albert Einstein College of Medicine in New York City, was not surprised by the findings, but thinks the trial is outdated.
- It certainly proves that Victoza and Lantus are better medications to improve blood sugar control when metformin is not enough,” he said.
- The problem with the study is that it didn’t include other drugs that were approved by the U.S.
- Food and Drug Administration when the study began, so there may be more effective drug combinations that are yet to be tested, Zonszein said.
“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? We have an excellent choice of medications, and there is no reason to have individuals with diabetes not well-treated,” he added.
And when managing diabetes, treating blood sugar is not the only consideration, Zonszein noted. “We treat each patient and individualize regimens accordingly. Treatment includes obesity, and hypertension, among others. We aim to improve and prolong a good quality of life,” he said. “For instance, the weight loss found with Victoza is important for many, and not found with the other agents in the study.
Victoza’s gastrointestinal side effects are also well-known, and these are decreased when using newer weekly drugs.” Although blood sugar levels are important, treatment aims to avoid or delay the complications of diabetes, Zonszein said. Because stroke and heart attack are the common causes of death among diabetes patients, treatment should include medications that prevent heart attack, stroke and other heart and vascular complications, as well as kidney disease.
The. trial is therefore outdated, and doesn’t help people or their health care providers to make decisions in 2021 — the train has left the station,” Zonszein said. “Treatment of diabetes has shifted towards individualizing therapy, using proper medications from the get-go. We now use medications that do not cause low blood sugar or need frequent blood sugar checking.
Certainly, we use medications that can help with weight loss and cause less cardiovascular complications,” he explained. Kahn said he is all for individualized treatment for type 2 diabetes. He also wishes that drug companies would do head-to-head trials of the newer drugs to determine the best combination treatment. Copyright © 2013-2022 HealthDay. All rights reserved. : Best Blood Sugar Meds for Type 2 Diabetes
What is the new treatment for type 2 diabetes?
In May 2022, the FDA approved Lilly’s new medication Mounjaro (also known as tirzepatide) for type 2 diabetes management, in addition to diet and exercise. This first-in-class medication has been shown to improve glucose levels and also dramatically improve weight in clinical trials.