Liraglutide (a glucagon-like peptide-1 receptor agonist)
Sitagliptin (a dipeptidyl peptidase 4 inhibitor)
A glycated hemoglobin level of ≥7.0% (measured quarterly)
Confirmed glycated hemoglobin level greater than 7.5%
Black: 19.8% | Hispanic or Latinx: 18.6%
Mean follow-up 5.0 years
Cumulative incidence of a glycated hemoglobin level of ≥7.0% differed significantly among the four groups, with glargine and liraglutide performing better than glimepiride and sitagliptin
Glargine: 26.5 per 100 participant-years
Liraglutide: 26.1 per 100 participant-years
Glimepiride: 30.4 per 100 participant-years
Sitagliptin: 38.1 per 100 participant-years
P<0.001 for a global test of differences across groups
The differences among the groups for glycated hemoglobin level ≥7.5% paralleled those of the primary outcome
No material differences found for primary outcome across prespecified subgroups defined according to sex, age, or race or ethnic group
For participants with higher baseline glycated hemoglobin levels
Greater benefit with glargine, liraglutide, and glimepiride vs sitagliptin
Severe hypoglycemia was rare but significantly more frequent with glimepiride
GI side effects and weight loss
More common with liraglutide
When combined with metformin, glargine and liraglutide were slightly better at achieving optimal glycemic profiles in patients with type 2 diabetes, compared to glimepiride and sitagliptin
The authors state
The major implication of the current trial is that maintenance of target glycated hemoglobin levels is challenging, even in a clinical trial in which all care is provided free of charge
Sitagliptin had less efficacy and durability than the other medications, particularly at higher baseline strata of glycated hemoglobin, and these findings as well as the different adverse-event profiles should be considered along with other clinical benefits and costs in selecting medications used to manage hyperglycemia in persons with type 2 diabetes
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