The search for the best diabetes medicine

An explosion of new drugs for type 2 diabetes have come on the market in recent years, leaving doctors and patients with a dilemma — which one should I use?

The question isn’t so much about the first drug doctors prescribe. Guidelines from the American Diabetes Association and other professional groups around the world say that metformin should be the first drug offered to patients.

Metformin, which has been used in Europe for decades, was approved by the U.S. Food and Drug Administration in 1994. Much of the research leading to that approval was led by Dr. Ralph DeFronzo, deputy director of University Health System’s Texas Diabetes Institute, and professor of medicine at the UT Health Science Center.

But for most patients, metformin stops working after a few years as the disease progresses. That leaves doctors with a range of drugs to offer next — often in combination with metformin. These drugs include sulfonylureas (the first oral diabetes medicine, available since the 1950s); DPP-4-inhibitors; GLP-1 analogues; and insulin injections.

All of these drugs work differently to lower blood sugar. All have somewhat different benefits and side effects.

“Doctors call us all the time,” said Dr. Eugenio Cersosimo, associate professor of medicine at the UT Health Science Center, and medical director of clinical research at TDI. “We at TDI are specialists. We’re the research center. They ask, which one should I use? And the answer is, we don’t know. We use different drugs in different patients, for different reasons. But it’s a guessing game.”

To finally answer that question, TDI and other centers across the country are taking part in GRADE, or Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study. The federally-funded study will recruit 5,000 patients, including about 150 in San Antonio. They will be randomly picked to take metformin plus one of four other diabetes medicines.

Julia Martinez, 50, of Crystal City, volunteered to take part in the study at TDI after reading about it on a trip to San Antonio. She was diagnosed five years ago and prescribed metformin.

“My general practitioner didn’t do a very good job educating me,” said Martinez, who works with troubled children in the Crystal City School District. “She just said, take this twice a day.”

Martinez has been happy with her experience in the study, and complimentary of the patience of the doctors and nurses at TDI.  “I’m learning how to manage my diabetes better. If I have a question about what they’re asking me to do with my medication or the management of it, they’re very helpful. I just have to pick up the phone and call them. They check with me periodically. It makes me feel very comfortable and trusting in them.”

The study will follow those patients for seven years, enough time for strong data to emerge.

For information about the study, call (210) 358-7200.

Photo courtesy Pixabay