Add-on liraglutide benefits overweight insulin pump users with poor glycemic control
medwireNews: Adding liraglutide to continuous subcutaneous insulin infusion (CSII) significantly reduces glycated hemoglobin (HbA1c) without increasing hypoglycemia in overweight and obese people with type 1 diabetes and suboptimal glycemic control, Danish research shows.
The study, by Thomas Dejgaard, from the Steno Diabetes Center Copenhagen, and colleagues found that mean HbA1c fell significantly from 8.2% (66 mmol/mol) to 7.7% (61 mmol/mol) after 26 weeks of treatment with the glucagon‐like peptide (GLP)‐1 receptor agonist at a dose of 1.8 mg/mg in addition to CSII.
By comparison, mean HbA1c increased marginally from 8.1% (66 mmol/mol) to 8.3% (68 mmol/mol) among individuals who instead received placebo alongside CSII.
Thus, there was a “clinically significant improvement” in mean HbA1c of 0.7% (7 mmol/mol) among the 22 participants randomly assigned to receive liraglutide relative to the 22 assigned to receive placebo, report the researchers in Diabetes, Obesity and Metabolism.
The reduction in HbA1c with liraglutide was accompanied by a significantly greater amount of time spent in target range (4–10 mmol/L) over the 26 weeks versus placebo, at 57% versus 45%, without an increase in the time spent in level 1 (glucose <4.0 mmol/L; 6 vs 6%) or level 2 (<3.0 mmol/L; 1 vs 2%) hypoglycemia.
In addition, people in the liraglutide group lost significantly more weight than those in the placebo group (6.8 vs 0.4 kg) despite weighing slightly less at baseline (85 vs 88 kg), and reduced their total insulin dose by 4.7 units/day compared with an increase of 2.8 units/day in the placebo group.
The researchers found that liraglutide was generally well tolerated, with gastrointestinal problems, particularly nausea, the most commonly reported adverse events. Generally, these events were transient, but five patients needed a temporary dose reduction, and one a permanent reduction, to 1.2 mg/day.
Dejgaard et al conclude: “The clinical use of GLP-1 [receptor agonists] may be limited in the general population of persons with type 1 diabetes; however, our results with an attractable benefit-risk profile suggest that liraglutide may be a promising adjunct treatment in a sub-population of obese patients treated with CSII and non-optimal glycaemic control.”
By Laura Cowen
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