Taiwanese Study Identifies Top Three Drugs for Type 2 Glycemic Control

| May 16, 2012

Researchers in Taipei, Taiwan, report that they have identified the top three drugs for reducing A1C levels in type 2 diabetes: biphasic insulin, GLP-1 analogs, and basal insulin. They hedged a little on their endorsement of GLP-1 analogs, however, by saying that although they are not decisively better at controlling A1Cs than other oral diabetes drugs, they have the advantage of helping to reduce weight without adding to the danger of hypoglycemia.

Biphasic insulin is a combination of intermediate- and fast-acting insulin. Basal insulin is the standard dose a person with diabetes takes daily, often supplemented by shorter-term bolus insulin to cover blood sugar spikes at meals. GLP-1 (glucagon-like peptide 1) analogs, which include exenatide and liraglutide, are derived from a gut hormone that helps increase insulin production and sensitivity and reduce glucagon production in the pancreas. A beneficial side effect is weight reduction.
The scientists at the Mackay Memorial Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan, reached their conclusion after conducting a meta-analysis of drugs used to treat type 2 diabetes that was inadequately controlled by metformin. The analysis eventually studied 819 articles on diabetes drugs, including coverage of 39 controlled trials that involved almost 18,000 patients.

Overall, GLP-1 analogs were found to lead to a greater decrease in A1C levels than sulfonylureas, glinides, thiazolidinediones, alpha-glucosidase inhibitors, and DPP-4 inhibitors, producing results similar to those of basal and biphasic insulin.

According to the Taiwanese researchers, the meta-analysis also showed that compared with placebo, sulfonylureas, glinides, basal insulin, and biphasic insulin carried an increased risk of hypoglycemia.

While the study conclusions are interesting, the researchers cautioned that of the studies they reviewed, the longest was only 52 weeks-not long enough to establish a definitive long-term trend.

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Categories: A1C, A1C Levels, Diabetes, Diabetes, Diabetes Health, Glucagon, Hypoglycemia, Insulin, Metformin, Research, Type 2 Diabetes, Type 2 Issues

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Posted by Anonymous on 16 May 2012

Whoa, what is this story saying? Are these the top three drugs after metformin? Or is metformin only a fourth-rate drug for controlling diabetes? The article strongly implies the later, and I doubt that is true.

Posted by Anonymous on 18 May 2012

Sounds similar what our clinical experience is showing. Metformin stays as the cornerstone - not necessarily for glucose control but reduction in all-cause mortality, which probably will be shown to be due to meformin killing dormant cancer cells. Treatment that avoids weight gain and hypos must be the beneficial options for our patients and for health care funders. We can no longer accept spending 80% of diabetes related costs for managing its complications.

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