Spotlight on liraglutide and insulin
The effects of adding liraglutide to insulin treatment were assessed by multiple studies published in the past month.
The effects of adding liraglutide to insulin treatment were assessed by multiple studies published in the past month.
A trial of 40 patients with poorly controlled type 1 diabetes, published by Diabetes Care on Oct. 20, found that those randomized to add liraglutide to their insulin regimens had no greater improvement in glycemic control than those who took a placebo instead (change in HbA1c at 12 weeks, −0.6 vs. −0.5; P=0.62). The liraglutide patients did have a significant decrease in bolus insulin doses and in weight (−3.3 kg) regardless of baseline weight (which suggests the need for cautious use of this drug in patients with low baseline weight), the authors noted. Liraglutide was also associated with more gastrointestinal side effects than placebo, but no difference in hypoglycemia. The lack of difference in HbA1c was contrary to expectations and some recent studies (none of which were randomized, double-blind, controlled trials), the authors noted.
However, a similar trial of 124 type 2 diabetes patients, published by the BMJ on Oct. 28, found a 1.5% improvement in HbA1c when patients added liraglutide to multiple daily insulin injections, compared to 0.4% with the addition of a placebo (difference, −1.13%; 95% CI, −1.45 to −0.81). The liraglutide group again showed significant reductions in body weight and insulin use, with no significant difference in hypoglycemia and an increase in nausea. The study was investigator-initiated but pharma-funded. The study was limited by its 24-week duration, and longer research is needed to fully assess the risk of side effects, the authors said. They noted that the average duration of diabetes in the trial was 17 years, leading them to conclude that “incretins are effective over the entire time continuum of type 2 diabetes.”
A third study, published by Diabetes, Obesity and Metabolism on Nov. 5, supported that conclusion. The post hoc analysis looked at 2 trials (DUAL I and DUAL II) that put patients with poorly controlled type 2 diabetes on combinations of insulin and/or liraglutide. Patients with HbA1cs ranging from under 7.5% to 9% showed significant improvement in their glucose control on liraglutide, the analysis found. The reduction in HbA1c was independent of disease duration. The authors noted that patients with HbA1c above 10% or body mass index above 40 kg/m2 were excluded but called the findings of efficacy across a wide spectrum of patients “reassuring.”