Type 1 diabetes

GLP-1 agonist a useful adjunct to insulin therapy in type 1 diabetes

Professor Paresh Dandona

Professor Paresh Dandona

Adults with type 1 diabetes may benefit from adjunctive treatment with liraglutide to improve glycaemic control and other risk factors for diabetes-related complications.

The American Diabetes Association’s 78th Scientific Sessions heard the results of a 52-week randomised controlled trial of daily liraglutide (1.8 mg) versus placebo as an adjunct to insulin therapy.

Patients in the control arm switched to liraglutide at 26 weeks. Continuous blood glucose monitoring (CGM) was performed for four weeks before and after treatment.

C-peptide concentrations were non-detectible at the beginning and end of the study suggesting that none of the patients had any beta-cell reserve.

Professor Paresh Dandona, head of endocrinology at the State University of New York, said earlier results from a 12-week study suggested the GLP-1 agonist could improve glycaemic control, weight loss and blood pressure.

The current study of 46 patients found liraglutide lead to a significant reduction in HbA1c from 7.92% to 7.45% at 52 weeks.

There was also a concurrent fall in insulin dose, mainly bolus, and a fall in fasting and weekly glucose levels.

Patients in the treatment arm, with an average BMI of 28.9 kg/m2, also demonstrated a significant weight loss of 2.5 kg.

Professor Dandona said the potential to reduce systolic blood pressure was extremely important for patients with diabetes.

The study found systolic blood pressure fell by about 9 mm Hg: ‘an amazing hypotensive effect in either type 2 or type 1 disease’, he said.

“The magnitude of improvement in blood glucose control in our study was significant, and this medication could have a positive impact on the lives of people with type 1 diabetes,” said Professor Dandona.

“Because the number of patients with adequate control of type 1 diabetes is small, the availability of an additional, effective drug like liraglutide could contribute greatly to the prevention of complications, improve quality of life, and make patients’ lives more stable and predictable.”

There were no changes in the reported incidence of hypoglycaemia and no changes in the proportion of time spent below 70mg/dl (3.9mmol/l) based on CGM.

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