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Prediction scale of response to liraglutide therapy as the method for increase of treatment efficacy in type 2 diabetes. Future Sci OA 2022; 8:FSO779. [PMID: 35251693 PMCID: PMC8890266 DOI: 10.2144/fsoa-2021-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The effects of liraglutide on body weight and hemoglobin A1C (HbA1c) level vary greatly. The cost of this drug negatively affects treatment adherence. Aim: To reveal the baseline patient characteristics, associated with a better response to liraglutide. Materials and methods: A total of 41 patients with BMI of 39.63 ± 7.59 kg/m2 who received liraglutide injection up to 1.8 or 3.0 mg/day for 6 months were enrolled. Demographic and anthropometric data, parameters of glycemic control, food intake, hormones and responses to the eating behavior questionnaire were collected. Results: Weight reduction was dose-dependent (p = 0.007). Liraglutide was not effective in patients with BMI >45 kg/m2. The baseline HbA1c level was a significant factor for HbA1c reduction. Lower leptin and higher glucagon-like-peptide 1 concentrations might predict better weight loss response to liraglutide. Conclusion: Drug-specific efficacy predictors were assumed; thus, further studies are needed to prove their significance. The objective of this study was to identify the baseline patient characteristics as a predictors associated with a better response to liraglutide. It is related to different effect of liraglutide on body weight and hemoglobin A1c (HbA1c) in different patients. We found that weight reduction was dose-dependent (p = 0.007) and liraglutide was not effective in patients with BMI >45 kg/m2. The baseline HbA1c level significantly correlated with HbA1c reduction. Lower leptin and higher glucagon-like peptide-1 concentrations might predict better weight loss response to liraglutide.
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High-Dose Liraglutide and SGLT2 Inhibitor: A Promising Combination. Clin Pract 2021; 12:1-7. [PMID: 35076486 PMCID: PMC8788265 DOI: 10.3390/clinpract12010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023] Open
Abstract
Sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists are important drugs in our armamentarium of treatment for Type 2 diabetes mellitus (DM). In addition to their glucose-lowering effects, they have effects on weight, other metabolic diseases and perhaps most importantly, a cardioprotective and reno-protective effect. Liraglutide is a long-acting GLP-1 agonist which was originally used at 1.8 mg daily for the treatment of DM. However, high-dose liraglutide—liraglutide 3 mg daily, has been demonstrated to be a safe and effective treatment for obesity, with or without DM. In this manuscript, I present two patients who had unusual responses to combination therapy with high-dose liraglutide and SGLT2 inhibitor—marked and/or rapid improvement in glycemic control and weight loss. Drawing from the observations in both cases, I discuss the complementary mechanisms of actions of both drugs, review the clinical effects of combination therapy and distil them into clinical pearls of practical utility for the physician. Given the “clash of the two pandemics” of obesity and COVID-19 and the burgeoning rates of obesity which loom in the near horizon, this is most timely.
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Yousef CC, Thomas A, Matar MA, Ghandoura L, Aldossary I, Almuhanna SM, Alhussain F, Al Bisher FB, Aljohani RM, Balubaid AN, Nouh MI, Almurashi A, AlAmoudi R. Liraglutide effects on glycemic control and weight in patients with type 2 diabetes Mellitus: A real-world, observational study and brief narrative review. Diabetes Res Clin Pract 2021; 177:108871. [PMID: 34052248 DOI: 10.1016/j.diabres.2021.108871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Glycemic control and weight gain are two essential considerations in the pharmacological management of type 2 diabetes mellitus. Pharmacological agents are effective in lowering blood glucose levels but may result in significant weight gain. Liraglutideeffectively maintains glycemic control while reducingweight. METHODS This is a real-world study and brief narrative review of the effects of liraglutide on glycemic control and weight in adult patients with type 2 diabetes mellitus. The study uses data extracted from the electronic health record of the Ministry of National Guard-Health Affairs. RESULTS In this study of 348 subjects, there was a statistically significant reduction in hemoglobin A1c of 0.9% (P < .0001) and weight of 2.3 kg (P < .0001). The majority (77.3%) were on concomitant insulin.Subjects with a baseline hemoglobin A1c greater than 9% had a significantly greater reduction than those below 9% (-0.7%;P < .0001). Those with a weight more than 100 kg had a significantly greater reduction than those below 100 kg (-0.9 kg;P = .0096). CONCLUSION In this real-world, observational study, liraglutide was shown to be effective in improving glycemic control and reducing weight in adult patients with type 2 diabetes mellitus.
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Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Dammam, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Abin Thomas
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Manar Al Matar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Lama Ghandoura
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Family Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Sarah Musa Almuhanna
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Fatimah Alhussain
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Fatmh Bisher Al Bisher
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Imam Abdulrahman Bin Faisal University, College of Clinical Pharmacy, Dammam, Saudi Arabia
| | - Raneem Mohammad Aljohani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ibn Sina National College, College of Clinical Pharmacy, Jeddah, Saudi Arabia
| | - Alya Najeeb Balubaid
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ibn Sina National College, College of Clinical Pharmacy, Jeddah, Saudi Arabia
| | - Mahmoud Ismail Nouh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Umm Al-Qura University, College of Pharmacy, Makkah, Saudi Arabia
| | - Abdulhalim Almurashi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; General Directorate of Health Affairs, Department of Family Medicine, Madinah, Saudi Arabia
| | - Reem AlAmoudi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
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Zhao J, Xu P, Liu X, Ji X, Li M, Dev S, Qu X, Lu W, Niu B. Application of machine learning methods for the development of antidiabetic drugs. Curr Pharm Des 2021; 28:260-271. [PMID: 34161205 DOI: 10.2174/1381612827666210622104428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
Diabetes is a chronic non-communicable disease caused by several different routes, which has attracted increasing attention. In order to speed up the development of new selective drugs, machine learning (ML) technology has been applied in the process of diabetes drug development, which opens up a new blueprint for drug design. This review provides a comprehensive portrayal of the application of ML in antidiabetic drug use.
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Affiliation(s)
- Juanjuan Zhao
- Department of Chemistry, College of Sciences, Shanghai University, 200444, China
| | - Pengcheng Xu
- Materials Genome Institute, Shanghai University, Shanghai 200444, China
| | - Xiujuan Liu
- Department of Chemistry, College of Sciences, Shanghai University, 200444, China
| | - Xiaobo Ji
- Department of Chemistry, College of Sciences, Shanghai University, 200444, China
| | - Minjie Li
- Department of Chemistry, College of Sciences, Shanghai University, 200444, China
| | - Sooranna Dev
- Department of Obstetrics and Gynaecology, Imperial College London, Fulham Road, London SW10 9 NH, United Kingdom
| | - Xiaosheng Qu
- National Engineering Laboratory of Southwest Endangered Medicinal Resources Development, Guangxi Botanical Garden of Medicinal Plants, No. 189, Changgang Road, 530023, Nanning, China
| | - Wencong Lu
- Department of Chemistry, College of Sciences, Shanghai University, 200444, China
| | - Bing Niu
- School of Life Sciences, Shanghai University, 200444, China
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Houda SM, Toshihiro U, Yuriko Y, Hiroyuki O, Reie M, Anna S, Masafumi M. Combination use of liraglutide and insulin to Japanese patients with multiple insulin injection: efficacy and cost. Diabetol Int 2020; 11:49-56. [PMID: 31950004 PMCID: PMC6942082 DOI: 10.1007/s13340-019-00404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The introduction of liraglutide in the treatment of patients with type 2 diabetes already taking insulin is still subject to discussion in terms of timing and benefits. Gradually intensive insulin therapy is hastily prescribed. Switching from multiple insulin injection (MII) to insulin and liraglutide is evaluated in this study. METHODOLOGY We studied 92 patients with type 2 diabetes previously under MII, C-peptide ≥ 1.5 ng/ml, divided into a group with reasonable glycemic control [RC: HbA1c < 8% (64 mmol/mol)] and another with a poor control [PC: HbA1c ≥ 8%, (64 mmol/mol)] after introduction of liraglutide and insulin therapy. RESULTS Except for HbA1c, there were no statistical differences between RC and PC groups. Basal insulin doses were adjusted to achieve the fasting plasma glucose of 90-120 mg/dl. HbA1c was significantly improved in both groups, from 9.6% ± 1.6 (81 mmol/mol) and 7.0% ± 0.6 (53 mmol/mol) to 8.0% ± 1.5 (64 mmol/mol) and 6.8 ± 0.5% (51 mmol/mol). Reduction of body weight was significant only in RC (from 70 ± 16 kg to 68 ± 16 kg, p < 0.01). All patients from RC group and 58% of PC group reached HbA1c < 8% without hypoglycemia. CONCLUSION This observation persuades us to propose the liraglutide and insulin combination to patients with C-peptide ≥ 1.5 ng/ml, regardless of the HbA1c.
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Affiliation(s)
- Sellami-Mnif Houda
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Umehara Toshihiro
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Yamazaki Yuriko
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Otake Hiroyuki
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Matoba Reie
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Sakashita Anna
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
| | - Matsuda Masafumi
- Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama-ken 350-8550 Japan
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Takeuchi M, Okamoto M, Watanabe N. Pharmacological Evaluation of SKL-18287, a New Long-Acting Glucagon-Like Peptide-1 Receptor Agonist with Enhanced Aggregation Propensity, in Rodent Models. Int J Pept Res Ther 2018. [DOI: 10.1007/s10989-018-9777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Simioni N, Berra C, Boemi M, Bossi AC, Candido R, Di Cianni G, Frontoni S, Genovese S, Ponzani P, Provenzano V, Russo GT, Sciangula L, Lapolla A, Bette C, Rossi MC. Predictors of treatment response to liraglutide in type 2 diabetes in a real-world setting. Acta Diabetol 2018; 55:557-568. [PMID: 29527621 PMCID: PMC5959971 DOI: 10.1007/s00592-018-1124-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
Abstract
AIMS There is an unmet need among healthcare providers to identify subgroups of patients with type 2 diabetes who are most likely to respond to treatment. METHODS Data were taken from electronic medical records of participants of an observational, retrospective study in Italy. We used logistic regression models to assess the odds of achieving glycated haemoglobin (HbA1c) reduction ≥ 1.0% point after 12-month treatment with liraglutide (primary endpoint), according to various patient-related factors. RECursive Partitioning and AMalgamation (RECPAM) analysis was used to identify distinct homogeneous patient subgroups with different odds of achieving the primary endpoint. RESULTS Data from 1325 patients were included, of which 577 (43.5%) achieved HbA1c reduction ≥ 1.0% point (10.9 mmol/mol) after 12 months. Logistic regression showed that for each additional 1% HbA1c at baseline, the odds of reaching this endpoint were increased 3.5 times (95% CI: 2.90-4.32). By use of RECPAM analysis, five distinct responder subgroups were identified, with baseline HbA1c and diabetes duration as the two splitting variables. Patients in the most poorly controlled subgroup (RECPAM Class 1, mean baseline HbA1c > 9.1% [76 mmol/mol]) had a 28-fold higher odds of reaching the endpoint versus patients in the best-controlled group (mean baseline HbA1c ≤ 7.5% [58 mmol/mol]). Mean HbA1c reduction from baseline was as large as - 2.2% (24 mol/mol) in the former versus - 0.1% (1.1 mmol/mol) in the latter. Mean weight reduction ranged from 2.5 to 4.3 kg across RECPAM subgroups. CONCLUSIONS Glycaemic response to liraglutide is largely driven by baseline HbA1c levels and, to a lesser extent, by diabetes duration.
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Affiliation(s)
- N Simioni
- Presidio Ospedaliero di Cittadella, Cittadella, Padua, Italy
| | - C Berra
- Humanitas Research Hospital, Rozzano, MI, Italy
| | | | - A C Bossi
- ASST Bergamo Ovest, Treviglio, BG, Italy
| | - R Candido
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - S Frontoni
- University of Rome Tor Vergata, Rome, Italy
| | - S Genovese
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - P Ponzani
- Ospedale La Colletta, ASL3 Genovese, Arenzano, Italy
| | - V Provenzano
- Centro Regionale di Riferimento Diabetologia ed Impianto Microinfusori Sicilia, Partinico, Palermo, Italy
| | - G T Russo
- University of Messina, Messina, Italy
| | - L Sciangula
- IRCCS Multimedica - Ospedale di Castellanza, Varese, Italy
| | | | - C Bette
- Novo Nordisk Spa, Rome, Italy
| | - M C Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio, 2, 65124, Pescara, Italy.
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McGovern A, Hinton W, Calderara S, Munro N, Whyte M, de Lusignan S. A Class Comparison of Medication Persistence in People with Type 2 Diabetes: A Retrospective Observational Study. Diabetes Ther 2018; 9:229-242. [PMID: 29302934 PMCID: PMC5801247 DOI: 10.1007/s13300-017-0361-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Longer medication persistence in type 2 diabetes (T2D) is associated with improved glycaemic control. It is not clear which oral therapies have the best persistence. The objective of this study was to compare medication persistence across different oral therapies in people with T2D. METHODS We performed a retrospective cohort analysis using a primary-care-based population, the Royal College of General Practitioners Research and Surveillance Centre cohort. We identified new prescriptions for oral diabetes medication in people with type 2 diabetes between January 1, 2004 and July 31, 2015. We compared median persistence across each class. We also compared non-persistence (defined as a prescription gap of ≥ 90 days) between classes, adjusting for confounders, using Cox regression. Confounders included: age, gender, ethnicity, socioeconomic status, alcohol use, smoking status, glycaemic control, diabetes duration, diabetes complications, comorbidities, and number of previous and concurrent diabetes medications. RESULTS We identified 60,327 adults with T2D. The majority 42,810 (70.9%) of those had one or more oral medications prescribed; we measured persistence in those patients (who were prescribed 55,728 oral medications in total). Metformin had the longest median persistence (3.04 years; 95% CI 2.94-3.12). The adjusted hazard ratios for non-persistence compared with metformin were: sulfonylureas HR 1.20 (1.16-1.24), DPP-4 inhibitors HR 1.43 (1.38-1.49), thiazolidinediones HR 1.71 (95% CI 1.64-1.77), SGLT2 inhibitors HR 1.04 (0.93-1.17), meglitinides HR 2.25 (1.97-2.58), and alpha-glucosidase inhibitors HR 2.45 (1.98-3.02). The analysis of SGLT2 inhibitors was limited by the short duration of follow-up for this new class. Other factors associated with reduced medication persistence were female gender, younger age, and non-white ethnicity. CONCLUSIONS Persistence is strongly influenced by medication class and should be considered when initiating treatments.
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Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK.
| | - William Hinton
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | | | - Neil Munro
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
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Dahlqvist S, Ahlén E, Filipsson K, Gustafsson T, Hirsch IB, Tuomilehto J, Imberg H, Ahrén B, Attvall S, Lind M. Variables associated with HbA1c and weight reductions when adding liraglutide to multiple daily insulin injections in persons with type 2 diabetes (MDI Liraglutide trial 3). BMJ Open Diabetes Res Care 2018; 6:e000464. [PMID: 29527308 PMCID: PMC5841497 DOI: 10.1136/bmjdrc-2017-000464] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate variables associated with hemoglobin A1c (HbA1c) and weight reduction when adding liraglutide to persons with type 2 diabetes treated with multiple daily insulin injections (MDI). RESEARCH DESIGN AND METHODS This was a reanalysis of a previous trial where 124 patients were enrolled in a double-blind, placebo-controlled, multicenter randomized trial carried out over 24 weeks. Predictors for effect on change in HbA1c and weight were analyzed within the treatment group and with concurrent interaction analyses. Correlation analyses for change in HbA1c and weight from baseline to week 24 were made. RESULTS The mean age at baseline was 63.7 years, 64.8% were men, the mean number of insulin injections was 4.4 per day, the mean daily insulin dose was 105 units and the mean HbA1c was 74.5 mmol/mol (9.0%). The mean HbA1c and weight reductions were 12.3 mmol/mol (1.13%; P<0.001) and 3.8 kg (P<0.001) greater in liraglutide than placebo-treated persons. There was no significant predictor for greater effect on HbA1c that existed in all analyses (univariate, multivariate and interaction analyses against controls). For a greater weight reduction when adding liraglutide, a lower HbA1c level at baseline was a predictor (liraglutide group P=0.002, P=0.020 for liraglutide group vs placebo). During follow-up in the liraglutide group, no significant correlation was found between change in weight and change in HbA1c (r=0.09, P=0.46), whereas a correlation existed between weight and insulin dose reduction (r=0.44, P<0.001). CONCLUSION Weight reduction becomes greater when adding liraglutide in patients with type 2 diabetes treated with MDI who had a lower HbA1c level compared with those with a higher HbA1c level. There was no correlation between reductions in HbA1c and weight when liraglutide was added, that is, different patient groups responded with HbA1c and weight reductions. TRIAL REGISTRATION NUMBER EudraCT nr: 2012-001941-42.
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Affiliation(s)
- Sofia Dahlqvist
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Elsa Ahlén
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Värnamo Hospital, Värnamo, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Karin Filipsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, Scania, Sweden
| | - Thomas Gustafsson
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA
| | - Jaakko Tuomilehto
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Research Division, Dasman Diabetes Institute, Dasman, Kuwait
| | - Henrik Imberg
- Statistiska Konsultgruppen, Gothenburg, Sweden
- Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden
| | - Bo Ahrén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Stig Attvall
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Lind
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Cai X, Yang W, Gao X, Zhou L, Han X, Ji L. Baseline Body Mass Index and the Efficacy of Hypoglycemic Treatment in Type 2 Diabetes: A Meta-Analysis. PLoS One 2016; 11:e0166625. [PMID: 27935975 PMCID: PMC5147850 DOI: 10.1371/journal.pone.0166625] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/01/2016] [Indexed: 12/20/2022] Open
Abstract
AIM The aim of this study is to compare the effects of hypoglycemic treatments in groups of patients categorized according to the mean baseline body mass indexes (BMIs). METHODS Studies were identified by a literature search and all the studies were double blind, placebo-controlled randomized trials in type 2 diabetes patients; study length of ≥12 weeks with the efficacy evaluated by changes in HbA1c from baseline in groups. The electronic search was first conducted in January 2015 and repeated in June 2015. RESULTS 227 studies were included. Treatment with sulfonylureas was compared with placebo in overweight patients and resulted in a significantly greater change in the HbA1c levels (weighted mean difference (WMD), -1.39%) compared to obese patients (WMD, -0.77%)(p<0.05). Treatment with metformin in overweight patients resulted in a comparable change in the HbA1c levels (WMD, -0.99%) compared to obese patients (WMD, -1.06%)(p>0.05). Treatment with alpha glucosidase inhibitors in normal weight patients was associated with a HbA1c change (WMD, -0.94%) that was comparable that in overweight (WMD, -0.72%) and obese patients (WMD, -0.56%)(p>0.05). Treatment with thiazolidinediones in normal weight patients was associated with a HbA1c change (WMD, -1.04%) that was comparable with that in overweight (WMD, -1.02%) and obese patients (WMD, -0.88%)(p>0.05). Treatment with DPP-4 inhibitors in normal weight patients was associated with a HbA1c change (WMD, -0.93%) that was comparable with that in overweight (WMD, -0.66%) and obese patients (WMD, -0.61%)(p>0.05). In total, of the seven hypoglycemic agents, regression analysis indicated that the mean baseline BMI was not associated with the mean HbA1c changes from baseline. CONCLUSION In each kind of hypoglycemic therapy in type 2 diabetes, the baseline BMI was not associated with the efficacy of HbA1c changes from baseline.
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Affiliation(s)
- Xiaoling Cai
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
| | - Wenjia Yang
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
| | - Xueying Gao
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
| | - Lingli Zhou
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
| | - Xueyao Han
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
| | - Linong Ji
- Peking University People’s Hospital, Endocrine & Metabolism Department, Beijing, China
- * E-mail:
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11
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Ostawal A, Mocevic E, Kragh N, Xu W. Clinical Effectiveness of Liraglutide in Type 2 Diabetes Treatment in the Real-World Setting: A Systematic Literature Review. Diabetes Ther 2016; 7:411-38. [PMID: 27350545 PMCID: PMC5014786 DOI: 10.1007/s13300-016-0180-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION In clinical trials, liraglutide has proven to be an effective drug for the treatment of type 2 diabetes mellitus (T2DM). The real-world effectiveness of liraglutide has been investigated in numerous studies. The aim of this systematic literature review is to collate evidence on the real-world clinical effectiveness of liraglutide. METHODS A review of publications from Medline, EMBASE, the Cochrane Library, and conference proceedings was conducted to identify observational studies that assessed the clinical effectiveness of liraglutide in real-world clinical practice. This review was conducted according to the National Institute of Health and Care Excellence (NICE) guidance. No language or time limits were applied, except to the conference proceedings (2013-2015). Endpoints for data extraction were decided a priori. Study quality appraisal was done for full-text journal articles. RESULTS Of 124 publications included in the review, 43 were full-text articles. Liraglutide significantly reduces glycated hemoglobin (HbA1c) within 6 months of initiating treatment (mean change in HbA1c from baseline: -0.9% to -2.2%; HbA1c <7.0%: 29.5-65.0%). The NICE composite endpoint (HbA1c reduction ≥1% and weight reduction ≥3%) was met in 16.9-47.0% of patients with liraglutide treatment. Liraglutide therapy led to a mean change in absolute weight from baseline of -1.3 to -8.65 kg. Liraglutide treatment was well tolerated in patients with T2DM. The rate of occurrence of hypoglycemia with liraglutide monotherapy was ≤0.8%. Hypoglycemia was more common in patients taking antidiabetic medications (0.0-15.2%) together with liraglutide. The beneficial glycemic and weight effect of liraglutide therapy in patients with T2DM was maintained for at least 12 months. CONCLUSION Evidence from observational studies reflecting real-world clinical practice demonstrates that liraglutide therapy improves glycemic control with a low risk of hypoglycemia, and is associated with significant weight loss in patients with T2DM. These observations are consistent with clinical trial findings. FUNDING Novo Nordisk A/S, Søborg, Denmark.
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Affiliation(s)
| | | | | | - Weiwei Xu
- Pharmerit International, Rotterdam, The Netherlands.
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Cai X, Yang W, Chen Y, Gao X, Zhou L, Zhang S, Han X, Ji L. Efficacy of hypoglycemic treatment in type 2 diabetes stratified by age or diagnosed age: a meta-analysis. Expert Opin Pharmacother 2016; 17:1591-8. [PMID: 27322963 DOI: 10.1080/14656566.2016.1202921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM To compare the effects of blood glucose lowering regimens in groups of patients categorized by baseline age and diagnosed age. METHODS Placebo-controlled randomized trials in type 2 diabetes patients with a study length ≥12 weeks were included. RESULTS A total of 246 trials were included. HbA1c changes from baseline corrected by placebo were comparable in sulfonylurea treatment between older and younger patients' groups (weighted mean difference (WMD), -1.28% vs -0.92%, p > 0.05). Treatment with metformin between groups resulted in a comparable change in HbA1c levels (WMD, -0.97% vs -1.23%, p > 0.05). Treatment with α-glucosidase inhibitor (WMD, -0.68% vs -0.67%, p > 0.05), treatment with thiazolidinedione (WMD, -0.74% vs -1.01%, p > 0.05), treatment with DPP-4 inhibitors (WMD, -0.67% vs -0.67%, p > 0.05), and treatment with SGLT2 inhibitors (WMD, -0.54% vs -0.67%, p > 0.05) between groups also resulted in comparable HbA1c changes. Treatment with GLP-1 analogs between groups in HbA1c changes were also comparable (p > 0.05). Regression analysis indicated that the baseline age or diagnosed age was not associated with the HbA1c changes from baseline. CONCLUSION In each hypoglycemic treatment, the baseline age or diagnosed age was not associated with the HbA1c changes from baseline.
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Affiliation(s)
- Xiaoling Cai
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Wenjia Yang
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Yifei Chen
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Xueying Gao
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Lingli Zhou
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Simin Zhang
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Xueyao Han
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
| | - Linong Ji
- a Endocrine & Metabolism Department , Peking University People's Hospital , Beijing , China
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Yamamoto T, Fukui T, Higuchi A, Ohara M, Hayashi T, Hirano T. A higher body mass index attenuates the long-term HbA1c-lowering effects of liraglutide in type 2 diabetes patients treated using sulfonylurea-based therapy. Diabetol Int 2016; 7:425-431. [PMID: 30603295 DOI: 10.1007/s13340-016-0269-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
Objective To identify the attenuating factor of glycated hemoglobin (HbA1c)-lowering effects of liraglutide in type 2 diabetes (T2D) patients over the long term. Methods Forty-six T2D patients received liraglutide-glimepiride combination therapy. Clinical characteristics were compared between the following two subgroups: the relapse group (≥0.4 % increase in HbA1c in 48 weeks compared to 12 weeks) and non-relapse group (remaining patients). A glucagon-loading test was performed to evaluate baseline endogenous insulin secretion. Results In the relapse group, significantly reduced HbA1c, as observed at 12 weeks, tended to increase at 24 and 48 weeks. In the non-relapse group, reduced HbA1c was maintained for 48 weeks. Body weight was decreased at 12 weeks and then recovered at 48 weeks in both groups. Baseline BMI was significantly higher in the relapse group than in the non-relapse group. Age, HbA1c, duration of diabetes, fasting C-peptide, daily glimepiride dose and the duration of glimepiride treatment were comparable between both groups. Multiple logistic regression analysis revealed that baseline BMI was independently associated with the relapse group. Conclusion A higher BMI is the leading factor for attenuating long-term glycemic control by liraglutide in T2D patients undergoing sulfonylurea-based therapy.
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Affiliation(s)
- Takeshi Yamamoto
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Tomoyasu Fukui
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Akiko Higuchi
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Makoto Ohara
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Toshiyuki Hayashi
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Tsutomu Hirano
- The Division of Diabetology, Metabolism and Endocrinology, The Department of Internal Medicine, Showa University of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
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McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S. Systematic review of adherence rates by medication class in type 2 diabetes: a study protocol. BMJ Open 2016; 6:e010469. [PMID: 26928029 PMCID: PMC4780063 DOI: 10.1136/bmjopen-2015-010469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Treatment options for type 2 diabetes are becoming increasingly complex with people often prescribed multiple medications, and may include both oral and injectable therapies. There is ongoing debate about which drug classes provide the optimum second-line and third-line treatment options. In the real world, patient adherence and persistence determines medication effectiveness. A better understanding of adherence may help inform the choice of second-line and third-line drug classes. METHODS AND ANALYSIS This systematic review will compare adherence and persistence rates across the different classes of medication available to people with type 2 diabetes. It will include all identified studies comparing medication adherence or persistence between two or more glucose-lowering medications in people with type 2 diabetes. Research databases (MEDLINE, EMBASE, The Cochrane Library, The Register of Controlled Trials, PsychINFO and CINAHL) will be searched for relevant articles, using a comprehensive search strategy. All identified medication trials and observational studies will be included which compare adherence or persistence across classes of diabetes medication. The characteristics and outcomes of all the included studies will be reported along with a study quality grade, assessed using the Cochrane Risk Assessment Tool. The quality of adjustment for confounders of adherence or persistence will be reported for each study. Where multiple (n ≥ 3) studies provide compare adherence or persistence across the same 2 medication classes, a meta-analysis will be performed. ETHICS AND DISSEMINATION No ethics approval is required. This review and meta-analysis (where possible) will provide important information on the relative patient adherence and persistence, with the different classes of diabetes therapies. Once complete, the results will be made available by peer-reviewed publication. TRIAL REGISTRATION NUMBER CRD42015027865.
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Affiliation(s)
- Andrew McGovern
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Zayd Tippu
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - William Hinton
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Neil Munro
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Martin Whyte
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Section of Clinical Medicine and Aging, University of Surrey, Guildford, UK
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Usui R, Yabe D, Kuwata H, Murotani K, Kurose T, Seino Y. Retrospective analysis of safety and efficacy of liraglutide monotherapy and sulfonylurea-combination therapy in Japanese type 2 diabetes: Association of remaining β-cell function and achievement of HbA1c target one year after initiation. J Diabetes Complications 2015; 29:1203-10. [PMID: 26279320 DOI: 10.1016/j.jdiacomp.2015.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/16/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
AIMS The GLP-1 receptor agonist liraglutide improves impaired pancreatic β-cell function, thereby exerting glucose-lowering effects. However, the association of remaining β-cell function with long-term therapeutic efficacy of liraglutide remains largely unknown. METHODS Patients with type 2 diabetes who started liraglutide as monotherapy or sulfonylurea-combination therapy were retrospectively analyzed to identify possible associations of indices related to β-cell function including increments of C-peptide immunoreactivity in glucagon stimulation test (GST-ΔCPR) with achievement of HbA1c <7.0% at 54weeks after liraglutide initiation. RESULTS Among 165 subjects continuing liraglutide for 54weeks, 66 received additional oral anti-diabetic drugs (OADs) during the period. Of those continuing liraglutide without receiving additional OADs, 41 subjects achieved HbA1c <7.0% at 54weeks, while 49 subjects did not. Subjects achieving HbA1c <7.0% showed higher values of GST-ΔCPR. Receiver-operating analysis revealed 2.34ng/mL as the cut-off value for HbA1c <7.0% achievement in these subjects. Subjects with GST-ΔCPR >2.34ng/mL showed continuous and substantial HbA1c reduction throughout the 54weeks. In Kaplan-Meier analysis, subjects with GST-ΔCPR >2.34ng/mL showed longer therapeutic durability of initial liraglutide therapy with no additional OADs or insulin. CONCLUSIONS Despite numerous limitations, these results indicate that long-term efficacy of liraglutide is associated with remaining β-cell function at initiation.
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Affiliation(s)
- Ryota Usui
- Center for Diabetes, Endocrinology, and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan
| | - Daisuke Yabe
- Center for Diabetes, Endocrinology, and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Center for Metabolism and Clinical Nutrition, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 1-5-6 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Hitoshi Kuwata
- Center for Diabetes, Endocrinology, and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan
| | - Kenta Murotani
- Center for Clinical Research, Aichi University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takeshi Kurose
- Center for Diabetes, Endocrinology, and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan
| | - Yutaka Seino
- Center for Diabetes, Endocrinology, and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan; Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan.
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