Diabetes: Effects of Addition of Liraglutide to Insulin

Nitesh D. Kuhadiya MD, MPH Assistant Professor of Medicine Section of Endocrinology,Diabetes and Metabolism University of Buffalo, New YorkMedicalResearch.com Interview with:
Nitesh D. Kuhadiya MD, MPH
Assistant Professor of Medicine
Section of Endocrinology,Diabetes and Metabolism
University of Buffalo, New York

MedicalResearch: What are the main findings of the study?

Dr. Kuhadiya: This is the first randomized clinical trial to show that the addition of liraglutide 1.2 and 1.8mg to insulin significantly reduces HbA1c, mean blood glucose, total insulin doses, body weight, carbohydrate intake, C-Reactive protein (a marker of cardiovascular risk), significantly improves quality of life and reduces systolic blood pressure(top number in a blood pressure reading) in 1.8mg group in patients with type 1 diabetes over a period of 12 weeks.

In 1.2mg, HbA1c fell by 0.78% from 7.84 to 7.06% and in 1.8mg group fell by 0.42% from 7.41 to 6.99% which means that more number of patients will be able to achieve HbA1c levels close to 7% and lower which is recommended by most diabetes organizations. Also the total daily dose of insulin fell by about 10-12 units in both groups.  The total daily carbohydrate intake in both the groups fell by an average of 40 grams.   There was a 5 kg weight loss in both 1.2 mg and 1.8 mg groups and both these groups on an average lowered their Body Mass Index from 29 to 28 kg/m2 .    In 1.8 mg group  there was fall in systolic blood pressure by 9 mm from  120 to 111 mm Hg.

The improvements seen are important because 40 to 50 percent of people with Type 1 diabetes have the metabolic syndrome(Cluster of risk factors, including high blood pressure, large waistline, high blood sugar, low HDL (“good”) cholesterol and high triglycerides (fats in the blood) which increases the chances of later developing Type 2 diabetes and heart disease.

Our findings have significant implications for the future treatment of patients with Type 1 Diabetes.

MedicalResearch: Were any of the findings unexpected?

Dr. Kuhadiya: In our previous two non-randomised clinical studies, we demonstrated the benefits of liraglutide however; we did not expect such remarkable fall in HbA1c in such a short period of time(i.e 3 months). In previous two studies the fall in HbA1c of approx. 0.5% was seen over a period of 6 months.  Also in this study we have shown for the first time that there is a reduction in daily carbohydrate intake by average of 40 grams with liraglutide in addition to reduction in blood pressure.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Kuhadiya: Addition of liraglutide 1.2 and 1.8mg to insulin significantly reduces HbA1c, mean blood glucose, total insulin doses, body weight, carbohydrate intake, C-Reactive protein (a marker of cardiovascular risk), significantly improves quality of life and reduces systolic blood pressure in 1.8mg group in patients with type 1 diabetes over a period of 12 weeks. No such changes were observed in 0.6 mg liraglutide and placebo groups except weight loss of 3 kg in o.6 mg group.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Kuhadiya: Long-term studies are now needed to establish the durability of benefits of liraglutide in type 1 diabetes. We are currently conducting two such studies to establish the durability of benefits of liraglutide over a period of 6 months to one year.

Citation:
American Association of Clinical Endocrinologist 2014 abstract

Liraglutide as additional treatment to insulin in patients with type 1 diabetes mellitus: a randomized clinical trial