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Second Line Diabetes Drug Linagliptin Effective

Although metformin is the most commonly prescribed initial drug treatment for diabetes, many patients stop responding to the drug. Now, researchers have found that a new drug, called , could significantly benefit people with .

The study, published in The Lancet, found that patients who took linagliptin gained significantly less weight and were also less likely to suffer from cardiovascular events, such as and stroke.

In 2008, it was estimated that diabetes affected almost 10% of the world’s population (375 million people). At present, there is insufficient evidence regarding which second-line drug treatments are more effective at recovering normal blood glucose levels.

The researchers explained: “When metformin and lifestyle interventions fail…in a patient with type 2 diabetes, the optimum choice for an additional pharmacotherapy is unclear.”

Usually, a class of drugs known as are offered to patients who do not respond to metform in addition to their metformin treatment. However, can cause weight gain, hypoglycemia, reduce patients quality of life, and increase the risk of heart attack and stroke.

Professor Baptist Gallwitz, of Tübingen University Hospital, Germany, said:

“Since hypoglycemia 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 program.”

Linagliptin, which was licensed in 2011, works by blocking an enzyme (dipeptidyl peptidase-4) involved in glucose metabolism. As a result, the body is able to increase the amount of insulin it secretes in a glucose-dependent manner, thus significantly reducing the risk of hypoglycemia.

The two year study, which involved 1,500 patients with Type 2 diabetes from 16 different countries, compared the effectiveness of linagliptin to – a commonly used sulphonylureas. Study participants had not achieved normal with metformin alone.

The researchers found that although both treatments improved glucose regulation, linagliptin produced significantly less severe side effects than glimepiride – 38% of patients treated with glimepiride experienced hypoglycemia vs. 7% of those treated with linagliptin.

Furthermore, patients who received linagliptin also suffered less cardiovascular events, such as heart attacks and strokes, than patients who received glimepiride. However, this finding needs to be confirmed in further studies, as the duration of this study was not long enough to provide reliable evidence that linagliptin is more effective at reducing cardiac risk than glimepiride.

In an associated report, Professor Andre Scheen of Liège University Hospital, Belgium, explained:

“Besides [glucose regulation], other outcomes are important to patients with diabetes, such as ease of administration, weight change, and incidence of hypoglycemia, which can all affect quality of life…The much lower risk of hypoglycemia associated with gliptins compared with sulphonylureas might be seen as a major advantage in some patients exposed to this complication, and could affect the choice of drug to be added as second-line treatment to metformin.”

Written by Grace Rattue


“2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial”
Prof Baptist Gallwitz MD,Julio Rosenstock MD,Thomas Rauch MD PhD,Sudipta Bhattacharya MSJ,Sanjay Patel MB ChB,Maximilian von Eynatten MD,Klaus A Dugi MD,Hans-Juergen Woerle MD The Lancet, 28 June 2012, DOI: 10.1016/S0140-6736(12)60691-6