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Liraglutide plus insulin improved HbA1c, body weight, QOL in patients with type 1 diabetes
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LAS VEGAS — Adding 1.2 mg and 1.8 mg of liraglutide to insulin significantly reduced HbA1c, mean blood glucose, insulin dose, body weight, carbohydrate intake and c-reactive protein while improving quality of life for patients with type 1 diabetes, according to a presenter at the AACE 23rd Annual Scientific & Clinical Congress.
“Since the discovery of insulin by Banting and Best in 1921, no significant advances have been made in the field of type 1 diabetes,” Nitesh D. Kuhadiya, MD, MPH, assisant professor of medicine at the University of Buffalo, said during his presentation. “Living with type 1 diabetes continues to remain a major challenge. It is akin to a wild horse that is very hard to train and it kicks you 10 times a day.”
Nitesh D. Kuhadiya
The researchers studied 72 patients who had with type 1 diabetes for at least 1 year, were on insulin therapy and had no detectable c-peptide in plasma (mean BMI: 30±1; mean body weight: 184±5 lbs; mean HbA1c: 7.57±0.09%; mean age: 44±2 years; mean age of diagnosis: 20±1 years). Fifty-four patients received 0.6 mg, 1.2 mg and 1.8 mg of liraglutide daily for 12 weeks; 18 patients were randomized to placebo. In the 1.2 mg and 1.8 mg groups, mean change in average blood glucose was –10±2 and –10.0±1mg/dl, respectively, (P<0.0001 vs. placebo). In the 1.2 mg group, HbA1c fell by 0.78% from 7.84±0.17% to 7.06±0.15% (P<0.0001, P<0.01 vs. placebo) and in the 1.8 mg group, HbA1c fell by 0.42% from 7.41±0.15 to 6.99±0.15 (P=0.001, P=0.39 vs. placebo).
During the 12-week period, the average total daily dose of insulin in the 1.2 mg group fell by 12.4±3.9 units and by 10.0±2.3 units in the 1.8 mg group (P<0.05 vs. baseline and placebo). There was a reduction in body weight by 11 lbs from 210±9 lbs to 199±9 lbs in the 1.2 mg group (P<0.001); from 182±10 lbs to 171±10 lbs in the 1.8 mg group (P<0.0001); and from 176±8 lbs to 170±9 lbs in the 0.6 mg group (P<0.01). The diabetes-specific quality of life significantly improved in both 1.2 mg and 1.8 mg groups. Patients in the 1.8 mg group also reported improvement in systolic blood pressure. Patients in the placebo group and those who were given the 0.6 mg liraglutide dosage did not report improvements in any of these areas except weight loss of 6 lbs.
“This is the first randomized clinical trial demonstrating that the addition of 1.2 mg and 1.8 mg of liraglutide to insulin significantly reduces HbA1c, mean blood glucose, body weight, carbohydrate intake and CRP; improves quality of life and reduces systolic blood pressure in the 1.8 mg group in type 1 diabetes,”Kuhadiya said. “Our findings have significant implications for the future treatment of patients with type 1 diabetes.”
For more information: Kuhadiya N. Abstract 1317. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Novo Nordisk funded this study. Kuhadiya received a grant award from the Endocrine Fellows Foundation.
Perspective
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George Grunberger, MD, FACP, FACE
This was a well-done, single center, albeit a relatively small study. Since it was done by the same staff, however, it has the flavor of a controlled study.
One of my own patients participated in the study and told me after the fact. Patients love the results, but then you have to think about the logistics — adding another injection, the cost of additional medication, potential for its side effects, and then, because it’s not indicated or on-label, who is going to pay for that?
The fact that there is less hypoglycemia, 25% less insulin use, drop in blood pressure, drop in weight, reducing those glycemic variations, this is an attractive way to do it. Now there are additional trials going on with GLP-1 receptor agonists in patients with type 1 diabetes and the FDA is also looking at potential use of liraglutide in obesity.
Like it or not, obesity is a bigger market than diabetes. If you have a treatment that works, why not? And, additional question pops up: now that we have weight loss drugs approved — should they be approved for diabetes prevention and/or treatment?
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