medwireNews: Obese patients with type 2 diabetes who receive treatment intensification with liraglutide may have better glycemic control than those given basal insulin, researchers report.
The results of this real-world study “confirm previously reported clinical findings from [randomized controlled trials] of liraglutide,” say Edith Heintjes (PHARMO Institute, Utrecht, the Netherlands) and colleagues.
The team used the Dutch PHARMO Database Network to compare changes in glycemic control, bodyweight, and cardiovascular risk factors among 231 obese patients receiving new prescriptions for the glucagon-like peptide-1 receptor agonist in addition to oral antidiabetic agents, and 231 propensity score-matched patients initiating add-on basal insulin therapy.
Although glycemic control improved in both groups, patients receiving liraglutide experienced a significantly greater reduction in glycated hemoglobin (HbA1c) levels from baseline to the 1-year follow-up than those given basal insulin, with least squares mean (LSM) reductions of 12.2 versus 8.8 mmol/mol from corresponding average baseline values of 68.1 and 70.2 mmol/mol.
Furthermore, the proportion of patients meeting their individual HbA1c target according to Dutch treatment guidelines (≤53 mmol/mol for patients aged <70 years; ≤58 mmol/mol for older patients with diabetes duration <10 years; and ≤64 mmol/mol for all remaining patients) increased from 16% to 45% in the liraglutide group, and from 11% to 38% in the basal insulin group.
Liraglutide-treated patients also had significantly greater LSM reductions in bodyweight and BMI over 1 year of treatment than those in the basal insulin group, at 6.0 versus 1.6 kg, and 2.1 versus 0.5 kg/m2, respectively.
Despite these benefits, the researchers note that changes in cardiovascular risk markers, including blood pressure and blood lipids, over the study duration were not significantly different between the two groups.
Writing in Diabetes, Obesity and Metabolism, Heintjes and colleagues caution that their study did not account for potentially confounding factors including hypoglycemia, comorbidities, and changes in oral antidiabetic agents. They also note that potential side effects of the liraglutide and basal insulin could not be evaluated.
Nonetheless, they believe that their study “adds important insights on the long-term clinical effectiveness of initiating liraglutide versus [basal insulin therapy] in obese [type 2 diabetes] patients in a real-world setting.”
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