Millions of people around the world live with type 2 diabetes, a condition in which the body cannot use insulin properly and blood sugar stays too high.
If blood sugar is not controlled over many years, it can damage the heart, kidneys, eyes, nerves, and other organs.
For this reason, doctors try to find treatments that keep blood sugar at healthy levels for as long as possible.
Most people with type 2 diabetes begin treatment with metformin. This medicine has been used for many years because it is effective, affordable, and generally safe.
However, many patients eventually need a second medicine because metformin alone is no longer enough to control their blood sugar.
A large research project called the GRADE study explored which second medicine works best with metformin. GRADE stands for Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study. It is one of the biggest and most detailed studies ever carried out on diabetes medicines.
More than 5,000 adults with type 2 diabetes took part in the study. Everyone was already taking metformin. Researchers randomly assigned each participant to also receive sitagliptin, liraglutide, glimepiride, or insulin glargine, then followed their progress for four years.
The scientists regularly checked whether participants could keep their blood sugar within the recommended target range. Good blood sugar control lowers the risk of serious health problems and helps people stay healthier over time.
The study found that two treatment combinations performed better than the others. People taking metformin together with liraglutide or insulin glargine were more likely to keep their blood sugar under control than those taking metformin with sitagliptin or glimepiride. These results were similar across different ages, sexes, and racial or ethnic groups.
Even so, the findings showed how difficult diabetes can be to manage. About three out of every four participants could not keep their blood sugar within the target range throughout the four-year study. This shows that medicines are important, but they are only one part of successful diabetes care.
Eating a healthy diet, staying physically active, maintaining a healthy weight, managing stress, and attending regular medical check-ups remain essential. Doctors also need to adjust treatment plans as a person’s health changes because no single approach works for everyone.
The researchers also found that people taking liraglutide experienced fewer heart-related problems than some of the other groups. This suggests the medicine may provide benefits beyond lowering blood sugar, especially for people who also have a high risk of heart disease.
The research was led by Dr. Henry Burch and colleagues and was published in The New England Journal of Medicine.
The findings give doctors stronger evidence when choosing a second medicine after metformin, while also showing that better treatments and more personalized care are still needed to help people manage type 2 diabetes over the long term.
If you care about diabetes, please read studies about the cooking connection between potatoes and diabetes, and low calorie diets may help reverse type 2 diabetes.
For more health information, please see recent studies about protein power: a new ally in diabetes management, and pineapple and diabetes: A sweet surprise.
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