medwireNews: Using the glucagon-like peptide-1 receptor agonist liraglutide in people with obesity and prediabetes is a “valuable” strategy for achieving weight loss, but the benefits are greater with caloric restriction (CR), researchers report in Diabetes, Obesity & Metabolism.
For the study, 88 adults (mean age 50.3 years, 68% women) with obesity and prediabetes were randomly assigned to receive 14 weeks of treatment with liraglutide at an escalating dose up to 1.8 mg/day, CR (–390 kcal), or the weight-neutral dipeptidyl peptidase-4 inhibitor sitagliptin 100 mg/day. The mean bodyweight at baseline was 108.5 kg among the 44 individuals in the liraglutide group, 109.9 kg among the 22 in the CR arm, and 112.4 kg among the 22 receiving sitagliptin.
After 14 weeks, Heidi Silver (Vanderbilt University Medical Center, Nashville, Tennessee, USA) and fellow investigators observed significant weight loss in the liraglutide and CR groups, with 22% and 44% achieving a 5% or greater weight loss, respectively. Specifically, individuals given liraglutide lost a mean of 2.5 kg in bodyweight, compared with 4.4 kg and 0.1 kg among people in the CR and sitagliptin arms, respectively. The estimated treatment difference between liraglutide and CR was 2.8 kg in favor of CR.
Treatment with liraglutide or CR also led to statistically significant reductions in total fat mass (1.5 and 3.9 kg, respectively) and body fat percentage (0.1 and 1.7 kg, respectively), whereas sitagliptin was associated with a 1.5 kg gain in fat mass and a 0.1 kg increase in total body fat percentage.
Again, the estimated differences between the liraglutide and CR arms favored the latter for both total fat mass loss (2.3 kg) and reduction in body fat percentage (1.3 kg).
The researchers say that the patients in the liraglutide group had a significant loss of total lean mass whereas the CR group did not. Thus, the CR group had a significantly higher reduction in the ratio of fat to lean mass, at 6.5% versus 2.2% with liraglutide.
The HOMA-IR score decreased significantly by 30.8% to 2.5 in the liraglutide group and by 35.4% to 2.2 in the CR group; the latter reduction was significantly associated with the lower consumption of added sugars and dietary glycemic load in the CR diet. By contrast, there was no significant change in the sitagliptin group.
Silver et al note that the differences in response to each treatment provide “useful information to enable healthcare providers to stratify patients to the most optimal intervention for their personal risk factors.”
They conclude: “Future investigation might be designed to further elucidate which individuals would derive the greatest benefit from either approach.”
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