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New second-line drug for type 2 diabetes shows promise

Adrian O'Dowd

Thursday, 28 June 2012

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A new second-line drug for type 2 diabetes leads to less hypoglycaemia, less weight gain and perhaps less cardiovascular risk for patients, claims a study published online today in The Lancet.

The drug linagliptin could have significant advantages over existing treatments for type 2 diabetes patients who do not respond to metformin, the most commonly prescribed initial drug treatment for the disease.

Diabetes affects around 347 million people worldwide and while metformin is the most commonly prescribed initial drug treatment for the disease, it can become ineffective in the long-term for many patients.

There is currently a lack of evidence for which second-line drug treatments offer patients in this situation the best chances of recovering normal blood sugar levels.

A team of German and US researchers, therefore, carried out a study, which took place over two years in 16 different countries involving more than 1,500 patients with type 2 diabetes who had not achieved normal glucose regulation through the use of metformin alone.

They wanted to examine the effects of linagliptin versus glimepiride, one of the most commonly used sulphonylureas – the class of drugs offered to diabetics who are not responding to metformin.

The sulphonylureas class of drugs including glimepiride can lead to hypoglycaemia and weight gain, which put patients at increased risk of heart attack and stroke, as well as reducing their quality of life.

The new drug, linagliptin was licensed in 2011 but this is the first long-term study to assess its efficacy and safety.

While the two treatments produced comparable improvements in patients’ glucose regulation, the study showed that the side effects of linagliptin appear to be considerably less severe than those attributed to glimepiride.

Only 7% of patients treated with linagliptin experiencing hypoglycaemia, compared to 38% of patients treated with glimepiride.

The group treated with linagliptin also experienced fewer heart attacks or strokes compared to those treated with glimepiride, although the authors said that further studies would be needed to confirm this, as the study was not long enough to provide reliable evidence that linagliptin resulted in reduced cardiac risk compared to glimepiride. The new drug also resulted in significantly less weight gain.

One of the study’s authors, Professor Baptist Gallwitz, of Tübingen University Hospital, Germany, said: “Since hypoglycaemia can have substantial negative clinical consequences in terms of cognitive function, mortality, morbidity, adherence to treatment, and quality of life, its prevention is a crucial component of any diabetes management programme.”

The authors concluded: “The findings could improve decision making for clinical treatment when metformin alone is insufficient."

DOI:10.1016/S0140-6736(12)60691-6

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