Liraglutide resulted in better glycemic control than glimepiride, with fewer hypoglycemic episodes.

Liraglutide, a human glucagonlike peptide 1 (GLP-1) analog, is safe and effective as once-daily initial pharmacologic therapy for treating type 2 diabetes, data suggest.

In a study, the drug produced superior glucose control with weight loss and little hypoglycemia compared with the long-acting sulphonylurea, glimepiride, according to data from a double-blind phase 3 trial. Findings appear in The Lancet (2008; published online ahead of print).

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Researchers randomly assigned 746 patients with early type 2 diabetes  to receive once-daily liraglutide (1.2 mg [251 patients] or 1.8 mg [247 patients]) or glimepiride 1.8 mg (248 patients)..

At the end of 52 weeks, hemoglobin A1c (HbA1c) decreased by 0.51% for the patients on glimepiride compared with 0.84% for patients on liraglutide 1.2 mg and 1.14% for patients on liraglutide 1.8 mg. Liraglutide treatment also was associated with greater declines in systolic BP.

Moreover, 62% of treatment-naïve patients treated with liraglutide 1.8 mg achieved an average reduction in blood sugar below the American Diabetes Association (ADA) target of HbA1c less than 7% and maintained this reduction over the 52-week study period.

Patients treated with liraglutide experienced significant weight loss compared with glimepiride-treated patients. A mean weight loss of 2.0 kg and 2.45 kg occurred with liraglutide 1.2 mg and 1.8 mg, respectively, compared with a mean weight gain of 1.12 kg with glimepiride.

No major hypoglycemic episodes were reported. The rate of minor hypoglycemic episodes was significantly lower in both liraglutide dose groups compared with the glimepiride-treated group. The most common GI-related adverse events with liraglutide were nausea, diarrhea, and vomiting, and most were transient. Other adverse events reported included flulike symptoms.

Liraglutide “basically acts to increase insulin output,” said principal study investigator Alan Garber, MD, PhD, professor of medicine and biochemistry& molecular biology at Baylor College of Medicine in Houston. “It has a minimal risk of hypoglycemia. At the same time, because of its GI and central nervous system effects, it reduces appetite and that results in weight loss.”

Liraglutide has a half-life of 13 hours, which makes it suitable for once-daily injection.  GLP-1 stimulates glucose-dependent insulin secretion, suppresses glucagon secretion, and appears to moderate appetite by delaying gastric emptying.

“You would have to think about using this drug early on for diabetes management because there may not be any beta cells left to save if the drug is started later rather than earlier,” Dr. Garber said. “This is quite a promising drug, and the study tends to indicate what it can do for patients with diabetes.”