Liraglutide Improves Glycemic Control in Type 2 Diabetics Treated with Multiple Daily Insulin Injections

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Paul S. Mueller, MD, MPH, FACP Reviewing Lind M et al., BMJ 2015 Oct 28; 351:h5364

Adding liraglutide also facilitated weight loss and lowered insulin doses.

The injectable glucagon-like peptide-1–receptor agonist liraglutide (Victoza) improves glycemic control in patients with type 2 diabetes who are treated with oral antidiabetic drugs or basal insulin therapy. However, liraglutide has not been studied in patients who are receiving both basal and prandial insulin. In this study from Sweden, 124 such patients (mean age, 64; mean duration of diabetes, 17 years) were randomized to daily subcutaneous liraglutide (titrated to 1.8 mg) or placebo, added to their basal and prandial insulin. At baseline, mean glycosylated hemoglobin (HbA1c) level was 9%, and mean body-mass index was 34 kg/m2.

At 24 weeks, mean decreases in baseline HbA1c level were greater in the liraglutide group than in the placebo group (1.5% vs. 0.4%); also, mean weight loss was greater with liraglutide (3.8 kg vs. no loss), as were mean decreases in total daily insulin doses (18 units vs. 2 units). All of these differences were significant. Hypoglycemic events did not differ between groups. Although nausea was more common in liraglutide patients (33% vs. 8%), satisfaction with treatment was higher with liraglutide.

Comment

In this industry-funded trial, adding daily liraglutide to daily insulin injections lowered HbA1c levels, body weight, and daily insulin doses in patients with advanced type 2 diabetes — noteworthy results, given how difficult it can be to achieve glycemic control without escalating insulin doses in some patients. One limitation of this study was its short duration; the effects of liraglutide on morbidity, mortality, and safety outcomes should be evaluated in longer trials.

 

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