MedWire News: Glucagon-like peptide (GLP)-1 analogs may be a particularly useful treatment for diabetes in patients who are at risk for weight gain or hypoglycemia, study findings suggest.
Michael Nauck (Diabeteszentrum Bad Lauterberg, Harz, Germany) and colleagues found that in patients also receiving metformin, the GLP-1 analog liraglutide showed similar efficacy to the sulfonylurea glimipiride in reducing hyperglycemia, but with better outcomes in terms of weight control and hypoglycemia.
“An oral antidiabetes drug such as metformin is commonly used in first-line pharmacotherapy for Type 2 diabetes,” the researchers write in the journal Diabetes Care.
“Sulfonylureas and thiazolidinediones are alternative antidiabetes drug therapies, but both can elicit weight gain, whereas sulfonylureas can elicit hypoglycemia,” they observe.
As part of the Liraglutide Effect and Action in Diabetes (LEAD)-2 study, Nauck and co-workers assessed 1091 patients with diabetes, all of whom received metformin therapy. In addition, participants were randomly assigned to receive liraglutide by subcutaneous injection at a dose of 0.6, 1.2, or 1.8 mg/day, glimepiride at 4 mg/day, or placebo.
After 26 weeks of treatment, glycated hemoglobin (HbA1c) values had improved significantly in all active treatment groups, with a mean decrease of 1.0% in those receiving glimepiride or the higher doses of liraglutide, and a decrease of 0.7% in those receiving 0.6 mg of liraglutide. HbA1c values increased by 0.1% in the placebo group.
All doses of liraglutide produced a decrease in mean body weight by the end of the study, of between 1.8 and 2.8 kg, compared with an average increase of 1.0 kg in the glimepiride group. Moreover, the incidence of minor hypoglycemia associated with liraglutide was comparable with placebo, at around 3%, compared with an incidence of 17% with glimepiride.
Liraglutide was associated with an increased risk for nausea, which was reported in 11–19% of patients receiving the GLP-1 analog, compared with 3–4% of those in the glimepiride and placebo groups, although this incidence declined over time, Nauck et al note.
Nevertheless, in view of these findings, “addition of once-daily liraglutide to metformin monotherapy is a viable treatment option if weight gain and hypoglycemia are a concern,” the investigators conclude.
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