Glycemia Reduction in Type 2 Diabetes — Glycemic Outcomes

This multicenter, randomized clinical trial compared the effectiveness of four glucose lowering medications (insulin glargine, liraglutide, glimepiride, and sitagliptin) added to metformin in 5,047 participants with type 2 diabetes. Over a mean follow up of 5 years, glargine and liraglutide were significantly more effective at maintaining target glycated hemoglobin levels (<7.0%) than glimepiride or sitagliptin. Primary outcome failure (confirmed HbA1c ≥7.0%) occurred in 67% (glargine), 68% (liraglutide), 72% (glimepiride), and 77% (sitagliptin) of participants. Severe hypoglycemia was rare but more frequent with glimepiride (2.2%). Liraglutide was associated with greater weight loss (3.5 kg) and gastrointestinal side effects. The trial highlights the challenges of long-term glycemic control and provides evidence to guide medication selection in type 2 diabetes management.

This multicenter, randomized clinical trial compared the effectiveness of four glucose lowering medications (insulin glargine, liraglutide, glimepiride, and sitagliptin) added to metformin in 5,047 participants with type 2 diabetes. Over a mean follow up of 5 years, glargine and liraglutide were significantly more effective at maintaining target glycated hemoglobin levels (<7.0%) than glimepiride or sitagliptin. Primary outcome failure (confirmed HbA1c ≥7.0%) occurred in 67% (glargine), 68% (liraglutide), 72% (glimepiride), and 77% (sitagliptin) of participants. Severe hypoglycemia was rare but more frequent with glimepiride (2.2%). Liraglutide was associated with greater weight loss (3.5 kg) and gastrointestinal side effects. The trial highlights the challenges of long-term glycemic control and provides evidence to guide medication selection in type 2 diabetes management.