When Metformin Isn't Enough

Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes, by Michael Nauck and colleagues. Diabetes Care 32:84–90, 2009

What is the problem and what is known about it so far?

Type 2 diabetes typically worsens over time as less and less insulin is produced by the pancreas. Usually, treatment for type 2 diabetes starts with lifestyle changes and a diabetes pill, such as metformin. Sulfonyureas and thiazolidinediones are other types of diabetes pills that can be considered, but both can cause weight gain, and sulfonyureas can cause more episodes of hypoglycemia (low blood glucose) than metformin. Liraglutide is a new injectable diabetes medicine. It is now under development as a possible alternative to available diabetes pills. Researchers are performing studies to find out how liraglutide compares to other diabetes medicines.

Why did the researchers do this particular study?

The researchers wanted to compare the effectiveness and safety of adding liraglutide, glimepiride (a sulfonylurea), or a dummy pill to metformin treatment for people with type 2 diabetes.

Who was studied?

The study included more than 1,000 adults with type 2 diabetes who had been taking either one type of diabetes pill or more than one type of diabetes pill for more than 3 months.

How was the study done?

Participants received liraglutide injections, glimepiride pills, or dummy pills in combination with metformin for 26 weeks. Researchers measured the participants' A1C and body weight at the start and end of the study and collected information about whether they experienced nausea or hypoglycemia while on the treatments.

What did the researchers find?

Adding liraglutide to metformin provided better diabetes control than metformin alone. The liraglutide-metformin combination controlled blood glucose as well as and caused less weight gain and hypoglycemia than a combination of glimepiride and metformin. Liraglutide caused more nausea than glimepiride, but the nausea declined over time.

What are the implications of the study?

Adding liraglutide to metformin may be a good treatment option for patients whose diabetes is not adequately controlled with metformin alone, especially when weight gain and hypoglycemia are a concern.

FOR MORE INFORMATION

Diabetes Medications

Medicines for Type 2 Diabetes (PDF 87 KG)

Diabetes: A Guide to Living Well