Liraglutide boosts preventive power of lifestyle intervention in prediabetes
medwireNews: Liraglutide enhances the positive effects of lifestyle intervention on weight loss and glycemic control in patients with prediabetes, show the 3-year outcomes of the SCALE Obesity and Prediabetes trial.
As reported in The Lancet, by the end of the treatment period, 2% of the 1472 patients taking daily liraglutide 3.0 mg, in addition to monthly lifestyle counseling, had received a diagnosis of type 2 diabetes, compared with 6% of the 738 patients receiving matched placebo injections plus counseling.
About half of the patients withdrew during the trial, however, with those in the liraglutide group and the placebo group more likely to withdraw because of side effects and ineffective treatment, respectively. After allowing for this, the researchers calculated diabetes rates of 3% and 11% in the liraglutide and placebo groups, respectively.
Moreover, 66% of patients taking liraglutide had returned to a state of normoglycemia by the end of the treatment period, compared with 36% of patients in the placebo group.
“Effectively, these results indicate that for every three people treated, one person would be expected to become normoglycaemic owing to liraglutide treatment alone,” write Olivia Farr and Christos Mantzoros, both from the Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA, in a linked commentary.
Patients’ bodyweight fell by an average of 6.1% in the liraglutide group, compared with 1.9% in the placebo group. The corresponding proportions for at least 5% bodyweight loss were 49.6% versus 23.7%, and 11.0% versus 3.1% of patients lost at least 15%.
The SCALE Obesity and Prediabetes data are encouraging, but remind us that a lot more still needs to be done.
Liraglutide treatment also resulted in significantly greater improvements than placebo in all other bodyweight-related endpoints, in all glycemic control endpoints except for C-peptide, and in systolic blood pressure, report Carel le Roux (University College Dublin, Ireland) and co-researchers.
In their commentary, Farr and Mantzoros note that the effects of liraglutide, while larger than those of other medications, are only on a par with those achieved with intensive lifestyle modification, while being considerably more expensive.
And they add that lifestyle modification “improves not only the risk for developing diabetes but also other components of metabolic syndrome such as hypertension and hyperlipidaemia.”
The commentators therefore believe that studies of the two approaches, both head-to-head and combined, are needed “to advance the field.”
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