Liraglutide may be an option for people with unresolved type 2 diabetes after metabolic surgery
medwireNews: Findings from the GRAVITAS trial indicate that use of the glucagon-like peptide (GLP)-1 receptor agonist liraglutide alongside a diet and physical activity intervention may improve glycemic control among people with persistent or recurrent type 2 diabetes after bariatric surgery.
The study included 80 individuals who had obesity and type 2 diabetes despite having undergone Roux-en-Y gastric bypass (n=61) or vertical sleeve gastrectomy (n=19) at least 1 year previously. Participants had an average BMI of approximately 37 kg/m2 at the time of study entry.
As reported in The Lancet Diabetes & Endocrinology, the 53 patients who were randomly assigned to receive liraglutide 1.8 mg/day experienced a significantly greater decline in glycated hemoglobin (HbA1c) levels from baseline to week 26 than the 27 given placebo, with an average difference of 1.22% (13.3 mmol/mol) between the two groups on multivariable linear regression analysis. Average baseline HbA1c levels were 7.9% (63.3 mmol/mol) in the liraglutide group and 7.4% (57.7 mmol/mol) in the placebo group.
All participants consumed an energy-restricted diet and were advised to do 150 min/week of physical activity in addition to receiving the study drugs.
The GRAVITAS (GLP-1 Receptor Agonist interVentIon for poor responders after bariAtric Surgery) investigators also found that participants given liraglutide achieved greater weight loss over 26 weeks than those in the placebo group, with a mean difference between the groups of 4.23 kg on multivariable analysis.
Moreover, 46% of individuals in the liraglutide group lost at least 5% of their bodyweight, compared with just 9% of those give placebo.
“The overall evidence supports the use of liraglutide as an adjunctive treatment in patients who have inadequate resolution of type 2 diabetes after metabolic surgery,” write Tricia Tan (Imperial College London, UK) and co-researchers.
They continue: “Our results emphasise the importance of multimodal interventions for this complex group of patients and suggest that surgical, medical, psychological, and nutritional therapies could have an additive, if not synergistic, effect in patients with suboptimal responses to metabolic surgery.”
The researchers note that the 1.8 mg/day maximum dose of liraglutide used in the GRAVITAS trial is the dose licensed for type 2 diabetes, and hypothesize that the higher 3.0 mg/day dose, currently approved for the treatment of obesity, may result in further weight loss.
“Trials with longer follow-up and exploring the use of the higher doses used for obesity treatment could provide more evidence for the long-term efficacy and safety of the combination of metabolic surgery with GLP-1 receptor agonists,” they conclude.
Writing in an accompanying comment, Geltrude Mingrone (Catholic University, Rome, Italy) says that “the investigators have provided evidence that there are non-invasive alternatives to revisional surgery in patients who do [not] obtain diabetes remission or who have diabetes relapse in association with weight regain after bariatric–metabolic surgery.”
She adds: “Although at the moment, it is difficult to envisage that pharmacological approaches could replace bariatric–metabolic surgery for severe obesity, in the future the alternation of drugs, gastric balloons, endosleeve, or other minimally invasive devices might represent—especially in patients with less severe obesity—a lifelong option.”
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