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Victoza Vs. SGLT-2 inhibitor for Better BG Control

Safety, efficacy of these new classes of diabetic medication require more detailed investigation.

Victoza belongs to a glucagon-like peptide-1 receptor agonist, which indicates for type 2 diabetes. It was developed by Danish drugmaker Novo Nordisk and was approved by the U.S. Food and Drug Administration in January 2010. Recently, Novo Nordisk published a meta-analysis, which included 17 randomized trials and presented it at the World Diabetes congress. The drugmaker stated Victoza could help patients reach their target blood glucose with a greater reduction in hemoglobin A1c, compared to sodium-glucose co-transporter (SGLT-2) inhibitors.

This meta-analysis study compared Victoza with other SGLT-2 inhibitors, like canagliflozin, empagliflozin, and dapagliflozin. The results showed patients with Victoza had better control and management of type 2 diabetes. In the results, Victoza (1.2mg/1.8mg) reduced 1.01%/1.18% HbA1c, canagliflozin (100mg/300mg) reduced 0.64%/0.79% HbA1c, and empagliflozin (10mg/25mg) reduced 0.32%/0.38% HbA1c. Other than the result from this meta-analysis, in 2014 the US Food and Drug Administration approved liraglutide for the treatment of obesity, which can help obese patients lose weight. Since obesity is one of the leading factors for causing diabetes, the effect of weight loss is an advantage for obese patients with type 2 diabetes.

Besides the meta-analysis study provided by Novo Nordisk, a systematic review was published in Diabetic Medicine in UK in June 2015, which also accessed the efficacy and safety of antihyperglycemic drugs in patients with type 2 diabetes who failed metformin and sulphonylurea combination therapy. Researchers analyzed 20 trials and included 13 diabetic medications, such as acarbose, canagliflozin, liraglutide, sitagliptin, and so on. Ligraglutide showed 1.2% of HbA1c reduction, 1.4 to 2kg of weight reduction, and the decrease of systolic blood pressure.

Due to the prevalence of type 2 diabetes, all of the world and the great medical expense of diabetic complications, more and more new diabetic medications were provided for patients to control their blood glucose levels. Lifestyle and metformin monotherapy were recommended for patients as the first line of type 2 diabetes treatment. However, those patients may need to add the second or the third medications to achieve their target goal due to the increase of insulin resistance and the failure of beta-cell function. People with type 2 diabetes fail oral therapy at a rate of 5-10% per year. Patients and their healthcare providers were concerned about the use of new diabetic medications and the long-term effects that are brought by new diabetic medications.

Healthcare providers should choose the proper diabetic medications for their patient in accordance to the patient’s individual needs. In the management of diabetes, some patients may require tight control of diabetes so they can use the medications with greater reduction in HbA1c. However, some older patients with commonalities may require less control of their blood glucose. In this case, they may need a medication with less reduction in HbA1c. According to clinical practice guidelines by the American Geriatrics Society, the risk of intensive glycemic control outweighs the benefits for frail older adults with life expectancy of less than 5 years. There are also many formulations provided to patients, like injection once weekly or traditional oral therapy. Based on duration of diabetes, age, patient preference, and known cardiovascular disease, healthcare providers could make a good choice for patients.

GLP-1 agonist and SGLT-2 inhibitors were relatively new medications in the market, and there was no doubt that they provide new options to treat type 2 diabetes and alternative ways to control diabetes. However, the safety and efficacy of these new classes of diabetic medication still require more detailed investigation.

Practice Pearls:

  • A meta-analysis study of  Victoza accessed the reduction of HbA1c and compared the results with SGLT-2 inhibitors.
  • The results showed Victoza achieved a greater HbA1c reduction in type 2 diabetes patients. Healthcare providers should choose the proper medications accordance to the needs of individual patient.
  • Since GLP-1 agonist and SGLT-2 inhibitors were new classes of diabetic .medications, more researches are needed to prove these findings.

Update:  Please review the latest information on Ketoacidosis and UTI’s when using the SGLT-2 inhibitors in Diabetes In Control Issue #811.

Novo Nordisk. Nova Nordisk says Victoza provides greater HbA1c reductions than SGLT2 inhibitors. December 2, 2015. <http://www.firstwordpharma.com/node/1336902?tsid=28&region_id=2#axzz3tpmDGogr>

Mearns ES, Saulsberry WJ, White CM, Kohn, CG, Lemieux S, Sihabout A, Salamucha I, Coleman CI. Systemic Review or Meta-analysis efficacy and safety of antihyperglycaemic drug regimens added to metformin and sulphonylurea therapy in type 2 diabetes: a network meta-analysis. Diabetic Medicine. June 2015. <http://onlinelibrary.wiley.com/doi/10.1111/dme.12837/epdf>