DIABETES: Different medications, differences in quality of life?

People with diabetes who keep their blood sugar levels close to normal usually have a much lower risk of developing diabetes complications such as heart, kidney and eye disease. The problem is that most of these diabetic patients actually require more than one medication to control their blood sugar levels over time.

GRADE Study was therefore designed to compare four major US FDA-approved drugs for the treatment of diabetes. in combination with metformin, the usual first-line drug. The Pennington Biomedical Research Center (Baton Rouge) team conducted the GRADE study for 8 years and previously published key 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 four drugs commonly used to treat type 2 diabetes:

1. insulin glargine (Lantus®),
2. liraglutide (GLP-1 analogue),
3. glimepiride,
4. sitagliptin.

The multicenter GRADE study recruited more than 5,000 volunteer volunteers with type 2 diabetes from diverse ethnic backgrounds and compared their outcomes, particularly blood sugar control, as a function of treatment with insulin glargine, liraglutide, glimepiride, and sitagliptin. The researchers took into account possible confounders, including age and baseline blood sugar levels. Key findings from this analysis include:

• adding liraglutide to metformin improves quality of life after the first year of treatment, but this benefit appears to decline thereafter;
• liraglutide provides greater weight loss, especially in patients with the highest initial weight.
• Insulin therapy is generally well accepted by participants and compliance is better than with other medications;
• thus, there were no observed adverse effects of insulin therapy on participants’ distress or quality of life: this suggests that, contrary to conventional wisdom, most patients tolerate insulin therapy and that it does not impair quality of life;
• another injectable drug, liraglutide, like insulin therapy, reduces the suffering associated with diabetes;
• There were no significant differences between groups in diabetes-related distress at 3-year follow-up; neither for depressive symptoms;
• In terms of efficacy, loss of insulin secretion appears to be closely associated with progressive deterioration of glycemic control across the four drugs, with insulin sensitivity consistently associated with treatment outcome;
• There were no differences between the four drugs in terms of mortality and the two most common causes of death, namely cardiovascular disease and cancer.

So while all four drugs have already been shown to be effective in treating diabetes, this new analysis provides important details

their impact on quality of life and diabetes-related suffering.

It also provides a new illustration of the need for individualized treatment and close monitoring of patients with diabetes.

“Diabetes and obesity are two major diseases that we study every day,”

the researchers conclude.