More than 34 million people in the U.S. have diabetes, reports the Centers for Disease Control and Prevention.

Of these, the vast majority have type 2, or a reduced ability of their bodies to effectively process sugar in foods into energy for life.

Most people with type 2 diabetes have multiple considerations – including heart and kidney health, impact on weight, side effects and cost – when choosing the most appropriate medication to lower their blood sugar levels. The American Diabetes Association recommends starting with metformin first, but other medications including insulin often need to be added as the disease progresses.

Individual care plans will vary. But the guidelines provide evidence-based recommendations for each additional medication that should inform choices. Rozalina McCoy, M.D., an endocrinologist and internal medicine physician at Mayo Clinic, wanted to find out if older people with type 2 diabetes are getting the best medications for their situation. A new study published in JAMA Network Open, shares her research findings.

"In the last few years, research has shown that in order to improve health outcomes for people living with diabetes, it is important not only to keep blood sugar within a safe range — not too low or too high — but also to carefully select the medications that we use to do this," says Dr. McCoy.

Two diabetes prescriptions that have benefits beyond lowering blood sugar are GLP-1 receptor agonist (GLP-1RA) and SGLT2 inhibitor (SGLT2i) medications. For example, GLP-1RA medications reduce the risk of cardiovascular events, kidney disease and death; SGLT2i drugs reduce the risk of heart failure, kidney disease and death; and both have a significantly lower risk of hypoglycemia (low blood sugar) than sulfonylureas and insulin, according to Dr. McCoy. A third class that can be used in addition to metformin is the DPP-4 inhibitor class, which does not have the beneficial heart, kidney, or mortality benefits, but is still safe to use and does not cause hypoglycemia.

"Sulfonylureas have been in use for a long time and are inexpensive. But they are not always the right choice when considering the patient’s clinical situation and highest threat to their health and life," she says. Because of that, the researchers wanted to know if people were getting the individualized care possible with the newer medication classes.

Metformin also has a low risk for hypoglycemia. The medications of interest to the researchers in this study would generally be added to metformin therapy if necessary.

Guidelines versus real life

"Diabetes is one of the most common serious chronic health conditions, and disproportionately affects racial and ethnic minorities," she says. "Our research and the work of others has consistently demonstrated that Black and Hispanic individuals, and lower income individuals of any race, are less likely to receive guideline-recommended treatments for their diabetes and more likely to experience severe hypoglycemia or hyperglycemia events."

Read the rest of the article on Advancing the Science.

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Other Mayo Clinic medical research websites:

• Research at Mayo Clinic
• Discovery’s Edge
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Center for Regenerative Medicine
• Center for the Science of Health Care Delivery

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