In a nutshell
This study compared the effectiveness and safety of liraglutide (Victoza) and sitagliptin (Januvia) in people with type 2 diabetes (T2D) who were being treated with metformin (Glucophage). It was determined that liraglutide controls blood glucose levels better, and results in more weight loss than sitagliptin. However, liraglutide was found to have more side effects.
Some background
Control of blood glucose levels is important to prevent the long-term complications of T2D. Lifestyle changes can control blood glucose levels at first. However, most people will eventually need medications.
Metformin is the first drug given to most people with T2D. It increases insulin sensitivity in the liver, decreasing the amount of glucose that the liver makes.
Eventually, many people with T2D will need more drugs to control blood glucose levels. Liraglutide is a glucagon-like peptide 1 receptor agonist (GLP1RA). Glucagon-like peptide 1 (GLP1) is made in the intestines and released after a meal. GLP-1 stimulates the release of insulin (the hormone that lowers blood glucose) and inhibits the release of glucagon (hormone that raises blood glucose). These hormonal changes control blood glucose levels. GLP1RAs are drugs that mimic the effects of GLP1. Sitagliptin is a dipeptidyl peptidase-4 (DPP4) inhibitor. DPP4 inhibitors prevent the breakdown of GLP1, thus controlling blood glucose levels.
It is not clear whether liraglutide or sitagliptin is more effective when used in combination with metformin.
Methods & findings
5 studies comparing liraglutide with sitagliptin in people with T2D who were also being treated with metformin were examined. 1440 adults with T2D participated in these studies. 829 received liraglutide plus metformin. 611 received sitagliptin plus metformin. The participants were treated for at least 16 weeks in each study.
HbA1c (measures average blood glucose over the last 3 months) was reduced more in the liraglutide group than in the sitagliptin group. The liraglutide group had significant weight loss compared with the sitagliptin group. Blood pressure was not significantly reduced in either group.
Gastrointestinal complaints (such as diarrhea, nausea, vomiting, and indigestion) were the most common side effects in both groups. Indigestion, diarrhea, and vomiting were 3.81 times more likely to occur in the liraglutide group than in the sitagliptin group.
The bottom line
The study concluded that liraglutide is better at controlling blood glucose, and results in more weight loss than sitagliptin. However, gastrointestinal side effects were found to be more common with liraglutide than with sitagliptin.
The fine print
Differences between the 5 studies may have made comparisons difficult.
What’s next?
Discuss the safety and effectiveness of GLP1RAs and DDP4 inhibitors with your physician.
Published By :
Medicine
Date :
Sep 01, 2017
