Liraglutide, metformin combination reduces risk for diabetes in postpartum women

NEW ORLEANS — The addition of liraglutide to metformin led to greater weight loss and improvements in insulin secretion and action in women who were overweight, obese and had a history of gestational diabetes when compared with metformin alone, according to study results presented at the American Diabetes Association Scientific Sessions.

The combination therapy was also more effective in reducing triglyceride to HDL-cholesterol ratio and mean blood glucose levels compared with metformin monotherapy, according to the researchers.

Karen Elkind-Hirsch

“We knew that getting the weight off [in this patient population] was critical,” Karen Elkind-Hirsch, PhD, MSc, HCLD, scientific director of research at Woman's Hospital in Baton Rouge, Louisiana, told Endocrine Today. “That was the impetus about perhaps using a glucagon-like peptide 1 receptor agonist, because we know a side effect is weight loss.”

Initiating weight loss is important, Elkind-Hirsch said, because gestational diabetes mellitus (GDM) is associated with maternal obesity, and obesity and weight gain are associated with an increased risk for type 2 diabetes.

Elkind-Hirsch and colleagues randomized 110 overweight women (BMI > 25 kg/m²) aged 18 to 45 years who experienced GDM within 12 months of pregnancy to either 2000 mg of metformin and 1.8 mg of subcutaneous liraglutide (Victoza, Novo Nordisk) or metformin at 2000 mg and placebo for 36 weeks.

Seventy-six women completed the 32 to 36-week follow-up visit. The results demonstrated that the combination therapy was more effective in reducing BMI (P = .018), triglyceride to HDL-cholesterol ratio (P < .03) and mean blood glucose levels (P < .03).

The researchers noted that impaired glucose regulation was identified in 15 patients on combination therapy and 9 patients who received metformin monotherapy.

Twelve patients who received the combination therapy and four patients who received metformin and placebo returned to normoglycemia (P < .025). The remaining 23 patients who received dual therapy showed improved or no significant change.

Elkind-Hirsch acknowledged that there are two more intervals that need to be tested before the study is completed.

“The reason that we did that was in the New England Journal of Medicine, there was a wonderful paper many years ago that looked at women with gestational diabetes and [the researchers] said ideally mothers should put 2 years between their children for the safety of their pancreas to recover,” she said. “I chose that they’re getting into the trial 3 or 4 months out and then I’m following them for 18 months and hopefully they’re healthier by the time that they get off the medications.” – by Ryan McDonald

Reference: Elkind-Hirsch K, et al. 1352-P. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.

Disclosure: Elkind-Hirsch reports that the study was supported by an unrestricted investigator funded grant from Novo Nordisk.