Liraglutide shows some benefits as adjunctive therapy in type 1 diabetes, review finds

A systematic review and meta-analysis of studies involving four glucagon-like peptide-1 receptor agonists found that liraglutide had the greatest effect on HbA1c level, weight, and total insulin dose, although odds of nausea and ketosis were higher.

Liraglutide may be useful as adjunctive therapy in patients with type 1 diabetes, according to a recent study.

Researchers performed a systematic review and meta-analysis of randomized trials published up to December 2022 to evaluate glucagon-like peptide 1 (GLP-1) receptor agonists as adjunctive therapy for type 1 diabetes. Efficacy outcomes were HbA1c level, body weight, and total daily insulin after at least 12 weeks of GLP-1 therapy, while adverse outcomes included nausea, hypo- and hyperglycemia, and ketosis. Patients with new diagnoses of type 1 diabetes and those who were C-peptide positive were included in subgroup analyses. The results were published Aug. 10 by the Journal of Clinical Endocrinology & Metabolism.

Twenty-four studies involving 3,377 patients were included. Average patient age was 39.3 years, and 54.8% were men. Sixteen studies involved liraglutide (12 at a dose of 1.8 mg/d), six trials involved exenatide, one involved albiglutide, and one involved lixisenatide. HbA1c level, weight, and total insulin dose decreased the most with liraglutide (−0.09%/mg, −2.2 kg/mg, and −4.32 IU/mg, respectively). Liraglutide was associated with higher odds of nausea (odds ratio [OR], 6.5; 95% CI, 5.0 to 8.4) and ketosis (OR, 1.8; 95% CI, 1.1 to 2.8) but not severe hypoglycemia (OR, 0.67; 95% CI, 0.43 to 1.04) or symptomatic hypoglycemia (OR, 0.89; 95% CI, 0.53 to 1.51) versus placebo. Patients who were positive for C-peptide had greater decreases in HbA1c level with 1.8 mg of liraglutide daily than those who were not (−0.51% vs. −0.28%), but weight loss and total insulin dose did not differ. Exenatide had effect sizes similar to liraglutide but in studies with higher risk for bias and with limited data on safety.

The authors noted that they did not directly address whether the clinical benefits of GLP-1 receptor agonists outweigh their side effects in patients with type 1 diabetes and that it's unclear whether the observed weight loss is sustainable, among other limitations. “Our meta-analysis supports therapeutic benefits of liraglutide for patients with [type 1 diabetes] mainly for weight loss and insulin dose reduction,” they wrote. “Newly diagnosed or [C-peptide-positive] patients do not appear to experience greater weight loss benefits.”