Medical professionals agree for appropriate patients with type 2 Diabetes, the first line oral medication should be metformin. The American Diabetes Association (ADA) deviated from its previous guidelines to recommend the choice of a second agent be individualized. How do medical professionals choose the second line agent? An article by Dr. Liu published in the April 9th edition of Diabetes, Obesity and Metabolism summarized in Med Scape attempted to answer that question by compiling data from a number of randomized control trials involving over 17,000 patients who were followed for 12-52 weeks. They noted a 1% decrease in A1C with the inject able GLP1 analogs ( ie. Byetta, Victoza ) and these results are comparable to basal insulin or combination insulin. Unlike insulin, patients on GLP1 analogs did not experience any hypoglycemia and/or weight gain. In fact most of them lost some weight. The other medication classes had about a .6% to .8% reduction in the A1C and these medications increased the risk of hypoglycemia and/or weight gain. Based on this review, the authors recommended the GLP1 analogs. Please note this study does not take into account the needed of individual patients who may have contraindication to the GLP1 analogs, the cost of the agents, or the inconvenience of needing injections. The study was also relatively short and long term data may be somewhat different, but it provides guidance for physicians who would like to look at available data to help them choose the best agent for an individual patient.
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