New second-line drug for type II diabetes results in less hypoglycaemia: The Lancet

According to a report published in The Lancet, a new drug could offer significant advantages over existing treatments for type II diabetes patients who don’t respond to metformin, the most commonly prescribed initial drug treatment for the disease. The new drug, linagliptin, results in significantly less weight gain than the most common second-line treatments currently used.

Metformin can become ineffective in the long-term for many patients. Usually, patients who do not respond to metformin alone are offered a class of drugs known as sulphonylureas in addition to their ongoing metformin treatment. However, sulphonylureas – which work by stimulating the cells in the pancreas to make more insulin, independently of blood glucose levels – can lead to hypoglycaemia (low blood sugar levels) and weight gain.

“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,” according to one of the study’s authors, Professor Baptist Gallwitz, of Tübingen University Hospital, Germany.

The new drug, linagliptin (one of a class of drugs called DPP-4 inhibitors, or ‘gliptins’), works in a different way to sulphonylureas, by blocking an enzyme known as dipeptidyl peptidase-4 which is involved in glucose metabolism. This allows the body to increase the amount of insulin it secretes in a glucose-dependent manner, resulting in a very low risk of hypoglycaemia. Linagliptin was licensed in 2011 but this is the first long-term study to assess its efficacy and safety.

The double-blind study, which took place over two years in sixteen different countries, examined the effects of linagliptin versus glimepiride, one of the most commonly used sulphonylureas, in more than 1,500 patients with type II diabetes who had not achieved normal glucose regulation through the use of metformin alone.

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, with just seven per cent of patients treated with linagliptin experiencing hypoglycaemia, compared to 38 per cent of patients treated with glimepiride. The group treated with linagliptin also experienced fewer cardiovascular events such as heart attacks or strokes compared to those treated with glimepiride, although the authors point out that further studies will be needed to confirm this.