Liraglutide enhances high-dose insulin treatment in Type 2 diabetes

By Eleanor McDermid

The addition of the glucagon-like peptide 1 receptor agonist liraglutide improves short-term outcomes and treatment satisfaction in patients who have uncontrolled Type 2 diabetes despite high doses of insulin, shows a randomised trial.

The 35 patients assigned to receive subcutaneous injections of liraglutide 1.8 mg/day achieved better glycaemic control and a decrease in weight, relative to the 36 given a placebo injection, report Ildiko Lingvay (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues.

"Furthermore, the addition of liraglutide led to clinically meaningful improvements in treatment satisfaction, an important consideration given the chronic nature of this disease and its long-term effect on daily life", write the researchers in JAMA Internal Medicine.

Patients taking liraglutide reported greater improvements in confidence that their blood glucose was under control, satisfaction with insulin treatment and willingness to continue with insulin treatment. This was despite neither they nor their clinicians being aware of whether they were taking liraglutide or placebo.

At baseline, the patients were aged an average of 54 years, had diabetes lasting a median of 17 years and had been insulin dependent for a median of 8 years. Their baseline daily insulin dose was at least 1.5 U/kg.

During 6 months of treatment, glycated haemoglobin levels fell from an average of 9.0% to 7.9% in the liraglutide group, but remained at 8.9% in the placebo group, with 22% versus 3% attaining a level below 7.0% by the end of treatment.

Average body mass index fell only slightly in the liraglutide group, from 40.7 to 40.1 kg/m², but it increased slightly in the placebo group, from 41.6 to 41.9 kg/m², so there was a significant difference between the changes in the two groups.

The median dose of insulin used fell from 2.1 to 1.6 U/kg per day in the liraglutide group and from 1.8 to 1.7 U/kg per day in the placebo group, but the between-group difference was not significant.

"The long-term durability of these benefits and the effect on future reduction in the risk of complications or adverse outcomes will be important to establish to justify the significant added cost of this treatment", say the researchers.

Patients taking liraglutide had a significant increase in hypoglycaemic events (glucose <70 mg/dL) during the first month of treatment relative to those taking placebo, at 2.30 versus 0.91 events per person-month, but the rate fell thereafter and the overall rate over the 6 months was not significantly increased.

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