During a vast clinical test directly comparing four drugs commonly used to treat Type 2 diabetes, researchers at the University of Minnesota Medical School helped find that insulin glargine and liraglutide worked best. The results were published in two journal articles The New England Journal of Medicine.
The GRADE study is the first to compare the effectiveness of four drugs commonly used to treat type 2 diabetes when added to metformin in people with short-term diabetes. Elle showed that liraglutide was superior to glimepiride and sitagliptin for the control of blood sugar. This study provides evidence that clinicians can use to develop treatment plans with their patient. »
Elizabeth Seaquist, MD, chair of the Department of Medicine at the University of Michigan Medical School and endocrinologist at M Health Fairview.
The study found that participants taking metformin plus liraglutide or insulin glargine reached and maintained their target blood sugar levels longer than sitagliptin or glimepiride. This translated to about six months longer with blood sugar levels in the target range compared to sitagliptin, which was the least effective in maintaining target levels. Treatment effects did not differ by age, sex, race or ethnicity. However, none of the combinations overwhelmingly outperformed the others.
Launched in 2013, the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study was conducted at centers across the country, including the University of Minnesota. It was designed to compare four major drugs approved by the Food and Drug Administration (FDA) at the time the GRADE study began to treat diabetes in combination with metformin. While healthcare professionals generally agree that metformin plus diet and exercise is the best initial approach in the treatment of diabetes, there is no consensus on what should be done next to better control hyperglycemia.
The GRADE study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098246). Additional support was provided by the National Heart, Lung, and Blood Institute; the National Institute of General Medical Sciences; the National Center for Advancing Translational Sciences; the Centers for Disease Control and Prevention; and the American Diabetes Association. The Department of Veterans Affairs provided resources and facilities. Material support in the form of drug and supply donations was provided by Becton, Dickinson and Company, Bristol-Myers Squibb, Merck & Co, Inc, Novo Nordisk, Roche Diagnostics and Sanofi. ClinicalTrials.gov number: NCT01794143.
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Journal reference:
GRADE Study Research Group., (2022) Blood sugar reduction in type 2 diabetes – blood glucose results. New England Journal of Medicine. doi.org/10.1056/NEJMoa2200433.