GRADE Study: Comparing Diabetes Medications for Better Blood Sugar Control and Quality of Life

2024-03-28 14:01:46

People with diabetes who maintain their blood sugar levels in a near-normal range generally have a much lower risk of developing diabetes complications such as heart, kidney, and eye disease. The challenge is that most of these diabetic patients actually need more than one medication to control their blood sugar levels over time.

The GRADE study was therefore designed to compare 4 major drugs – approved by the American FDA Agency – to treat diabetes in combination with metformin, the usual first-line drug. The team at Pennington Biomedical Research Center (Baton Rouge) has been running the GRADE study for 8 years and previously published major findings on the relative differences between blood glucose (sugar) levels and the occurrence of cardiovascular problems, such as heart attacks. and stroke, in the New England Journal of Medicine (NEJM, September 2022). The analysis reports other important differences between the 4 drugs commonly used to treat type 2 diabetes:

insulin glargine (Lantus ®),

liraglutide (GLP-1 analogue),

glimepiride,

to sitagliptin.

The multisite GRADE study followed more than 5,000 type 2 diabetic volunteer participants of different ethnic origins and compared their results, in particular blood sugar control, according to treatment, either with insulin glargine, liraglutide, glimepiride and sitagliptin. The researchers took into account possible confounding factors, including age and baseline blood sugar levels. Among the main conclusions of this analysis:

the addition of liraglutide to metformin improves quality of life after the first year of treatment, but this advantage seems to decline thereafter;
liraglutide provides greater weight loss, especially in patients with the highest weight at baseline.
insulin therapy is generally well accepted by participants, with better compliance than for other medications;
thus, no adverse effects of insulin therapy were observed on the distress or quality of life of the participants: this suggests that contrary to the generally accepted idea, the majority of patients tolerate insulin therapy and that it does not degrade the quality of life;
the other injectable drug, liraglutide, like insulin therapy, reduces diabetes-related distress;
over a 3-year follow-up, no significant difference between the groups was observed in terms of diabetes-related distress; nor for depressive symptoms;
on effectiveness, the loss of insulin secretion appears to be closely linked to the progressive deterioration of glycemic control with the 4 drugs, with insulin sensitivity always being closely linked to treatment results;
no difference is observed between the 4 drugs, in terms of mortality and for the 2 most frequent causes of death, namely cardiovascular diseases and cancer.

Thus, while the 4 drugs have already demonstrated their respective effectiveness in the treatment of diabetes, this new analysis provides important details on