Newer ‘Second-Line’ Diabetes Drug May Outperform Older Meds

THURSDAY, June 28 (HealthDay News) — A new drug for type 2
diabetes causes significantly less weight gain and may carry lower risks
for hypoglycemia (low blood sugar), heart attack and stroke than standard
medications, a new study indicates.

Researchers in Germany noted that the new drug, linagliptin
(Tradjenta), is intended for use in patients that do not fare well with
metformin, the most common first-line drug used to treat the disease.

Patients with type 2 diabetes may stop responding to metformin over
time. Others who do not respond to metformin alone are given a second drug
to help them maintain normal blood sugar levels. The researchers noted
that which drug they should be prescribed is unclear.

The researchers pointed out that most patients are prescribed a class
of drugs called sulphonylureas to supplement metformin. However, these
drugs can sometimes lead to hypoglycemia and weight gain, which increases
the patients’ risk for heart attack and stroke.

To compare the effects of linagliptin to glimepiride (the most commonly
used sulphonylurea), the researchers conducted a double-blind study over
the course of two years. The study, which was funded by linagliptin’s
maker, Boehringer Ingelheim, involved 1,500 people from 16 countries with
type 2 diabetes. None of the patients had responded to metformin
alone.

Although the effectiveness of the drugs were similar, the study showed
the side effects of linagliptin were much less severe than those of
glimepiride. The researchers found that 7 percent of patients on
linagliptin experienced hypoglycemia, compared to 38 percent of patients
treated with glimepiride.

The patients on linagliptin also had fewer heart attacks and strokes
compared to those being treated with glimepiride.

The researchers argued that since linagliptin allows the body to
increase the amount of insulin it produces in a glucose-dependent way, the
risk for hypoglycemia may be significantly lower.

And since hypoglycemia “can have substantial negative clinical
consequences” in terms of risk for death, illness, mental function and
poor quality of life, preventing it is crucial, study co-author Baptist
Gallwitz, of Tubingen University Hospital, said in a news release.

The study authors pointed out linagliptin was licensed in 2011 and this
is the first long-term study examining its safety and effectiveness. They
added more research is needed to confirm their findings.

One expert said patients and doctors may still have to balance the
superiority of linagliptin against its higher cost in comparison to older
drugs.

The new study provides more evidence that drugs like linagliptin “are
just as good as the old standby sulfonylurea therapies, with the added
benefits of inducing fewer hypoglycemic events, causing less weight gain,
along with a likely decrease in cardiovascular events,” said Dr. Stuart
Weiss, an endocrinologist at NYU Langone Medical Center and clinical
assistant professor at the NYU School of Medicine, New York City.

But millions of Americans suffer from type 2 diabetes, so “cost issues
favoring sulfonylureas may be the only reason for preferring continued
sulfonylurea use,” he added. The results of a larger, ongoing study
currently underway may help resolve the issue of whether the newer drug is
worth the extra money, Weiss said.

The study was published online June 27 in The Lancet.

More information

The American Diabetes Association provides more information on
type 2 diabetes
.

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