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Tibaldi J, Mercado ME, Strong J. How Effective Is the Fixed-Ratio Combination of Insulin Degludec and Liraglutide (IDegLira) in Different Patient Populations, and When Should It Be Used in Clinical Practice? Clin Diabetes 2020; 38:339-347. [PMID: 33132503 PMCID: PMC7566936 DOI: 10.2337/cd20-0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The efficacy and safety of the fixed-ratio combination of insulin degludec (degludec) and liraglutide (IDegLira) were confirmed in the DUAL clinical trial program, in which IDegLira demonstrated superior or noninferior glycemic control over comparators in addition to its low risks of hypoglycemia and weight gain. This article identifies the patient types for whom IDegLira is most appropriate by reviewing the DUAL results and subsequent post hoc analyses and presenting real-world cases in which IDegLira has been used effectively in U.S. clinical practice. In the clinic, IDegLira has been used effectively when patients wanted to avoid more complex injectable regimens, particularly those with renal insufficiency for whom treatment options are limited.
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Affiliation(s)
- Joseph Tibaldi
- Department of Medicine, New York Presbyterian Queens, New York, NY
| | | | - Jodi Strong
- Ascension St. Michael’s Hospital, Stevens Point, WI
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Zhao X, Huang K, Zheng M, Duan J. Effect of liraglutide on blood pressure: a meta-analysis of liraglutide randomized controlled trials. BMC Endocr Disord 2019; 19:4. [PMID: 30616638 PMCID: PMC6323665 DOI: 10.1186/s12902-018-0332-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Several clinical trials have studied the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on glycometabolism and cardiovascular risk factors since they were identified. Because of their cardiovascular benefits and efficacy in lowering glucose, GLP-1RAs are becoming increasingly important in clinical therapy for patients with or without pathoglycaemia. The aim of this study was to assess the effect of the GLP-1RA liraglutide on blood pressure based on randomised controlled trials (RCTs). METHODS We searched PubMed for RCTs published from 2009 to 2018 comparing the effect of liraglutide on blood pressure with that of placebo in individuals with or without pathoglycaemia. RCTs in humans that included data describing blood pressure changes from baseline to the end of the trial were selected for inclusion in the meta-analysis. RESULTS A total of 18 RCTs that enrolled 7616 individuals in the liraglutide group and 6046 individuals in the control group were included in this meta-analysis. Compared with placebo, liraglutide reduced systolic blood pressure (SBP) by 3.18 mmHg (95% CI -4.32, - 2.05), P < 0.00001, but had no significant effect on diastolic blood pressure (DBP). Subgroup analysis showed that the degree of reduction in SBP was associated with the dose of liraglutide but that significance disappeared when the intervention lasted over 1 year. Liraglutide 3.0 mg/d significantly reduced DBP by 1.46 mmHg (95% CI -2.61, 0.32), P = 0.01, but liraglutide 1.8 mg/d slightly increased DBP by 0.47 mmHg (95% CI 0.11, 0.83), P = 0.01, compared with placebo. CONCLUSIONS This meta-analysis demonstrated that liraglutide significantly reduced SBP in individuals with or without pathoglycaemia compared with placebo, but the difference was no longer significant when the intervention lasted over 1 year. Moreover, the effect of liraglutide on blood pressure is associated with the dose. This finding may provide additional evidence for cardiovascular protection.
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Affiliation(s)
- Xu Zhao
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Kun Huang
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Meijie Zheng
- Civil Aviation General Hospital, Peking University, Beijing, China
| | - Junting Duan
- Civil Aviation General Hospital, Peking University, Beijing, China
- Endocrinology Department, Civil Aviation General Hospital, Chaoyang Road, 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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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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Seino Y, Yabe D, Takami A, Niemoeller E, Takagi H. Long-term safety of once-daily lixisenatide in Japanese patients with type 2 diabetes mellitus: GetGoal-Mono-Japan. J Diabetes Complications 2015; 29:1304-9. [PMID: 26342556 DOI: 10.1016/j.jdiacomp.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 02/03/2023]
Abstract
AIMS This 76-week, open-label, parallel-group study assessed the long-term safety of once-daily lixisenatide monotherapy in Japanese patients with type 2 diabetes mellitus. METHODS Patients were randomized to receive lixisenatide in a 2-step or a 1-step dose-increase regimen. The primary objective was to assess the safety of lixisenatide at week 24 by a descriptive comparison of the 2- and 1-step groups. RESULTS As expected with treatment with a glucagon-like peptide-1 agonist, nausea was the most common treatment-emergent adverse event (2-step group: n=12/33 [36.4%] vs 1-step group: n=18/36 [50.0%] up to week 24). In total, 5/33 patients (15.2%; 2-step group) and 2/36 patients (5.6%; 1-step group) prematurely discontinued treatment up to week 24, mainly due to adverse events. Serious treatment-emergent adverse events occurred in 2/33 patients (6.1%; 2-step group) versus 0/36 patients (0%; 1-step group) up to week 24. Symptomatic hypoglycemia occurred in 2/33 patients (6.1%; 2-step group) versus 1/36 patients (2.8%; 1-step group) up to week 24, with no severe events reported. Glycated hemoglobin, fasting plasma glucose, and body weight were reduced from baseline at weeks 24 and 76. CONCLUSION In Japanese patients with type 2 diabetes mellitus, once-daily lixisenatide monotherapy was well tolerated, with less nausea with the 2-step regimen.
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Affiliation(s)
- Yutaka Seino
- Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Osaka, Japan.
| | - Daisuke Yabe
- Diabetes, Clinical Nutrition and Endocrinology, Kansai Electric Power Hospital, Osaka, Japan
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Miyagawa J, Odawara M, Takamura T, Iwamoto N, Takita Y, Imaoka T. Once-weekly glucagon-like peptide-1 receptor agonist dulaglutide is non-inferior to once-daily liraglutide and superior to placebo in Japanese patients with type 2 diabetes: a 26-week randomized phase III study. Diabetes Obes Metab 2015; 17:974-83. [PMID: 26179187 PMCID: PMC5042083 DOI: 10.1111/dom.12534] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/22/2015] [Accepted: 07/02/2015] [Indexed: 01/13/2023]
Abstract
AIMS To examine the efficacy and safety of once-weekly dulaglutide monotherapy (0.75 mg) compared with placebo and once-daily liraglutide (0.9 mg) in Japanese patients with type 2 diabetes. METHODS This was a phase III, 52-week (26-week primary endpoint), randomized, double-blind, placebo-controlled, open-label comparator (liraglutide) trial comparing 492 Japanese patients with type 2 diabetes (dulaglutide, n = 281; liraglutide, n = 141; and placebo, n = 70) who were aged ≥20 years. Patients and investigators were blinded to treatment assignment for dulaglutide and placebo but not for liraglutide. The primary objective evaluated the superiority of dulaglutide versus placebo on change from baseline in glycated haemoglobin (HbA1c) at 26 weeks. Analyses were performed on the full analysis set. RESULTS At 26 weeks, once-weekly dulaglutide was superior to placebo and non-inferior to once-daily liraglutide for HbA1c change from baseline [least squares mean difference: dulaglutide vs placebo -1.57% (95% confidence interval -1.79 to -1.35); dulaglutide vs liraglutide -0.10% (95% confidence interval -0.27 to 0.07)]. The most frequently reported adverse events were nasopharyngitis, constipation, diarrhoea, nausea, abdominal distension and decreased appetite; only decreased appetite was different between the dulaglutide and liraglutide groups [dulaglutide, n = 2 (0.7%); liraglutide, n = 8 (5.8%); p = 0.003]. Nine (1.8%) patients experienced hypoglycaemia [dulaglutide, n = 6 (2.1%); liraglutide, n = 2 (1.5%); placebo, n = 1 (1.4%)], with no event being severe. CONCLUSIONS In Japanese patients with type 2 diabetes, once-weekly dulaglutide (0.75 mg) was superior to placebo and non-inferior to once-daily liraglutide (0.9 mg) for reduction in HbA1c at 26 weeks. Dulaglutide was safe and well tolerated.
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Affiliation(s)
- J Miyagawa
- Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - M Odawara
- Division of Diabetes, Endocrinology and Metabolism, Department of Diabetes, Endocrinology, Metabolism and Rheumatology, Tokyo Medical University, Tokyo, Japan
| | - T Takamura
- Department of Comprehensive Metabology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | | | - Y Takita
- Eli Lilly Japan K.K, Kobe, Japan
| | - T Imaoka
- Eli Lilly Japan K.K, Kobe, Japan
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Abstract
Type 2 diabetes (T2DM) is one of the most serious global health problems and is mainly a result of the drastic increase in East Asia, which includes over a fourth of the global diabetes population. Lifestyle factors and ethnicity are two determinants in the etiology of T2DM, and lifestyle changes such as higher fat intake and less physical activity link readily to T2DM in East Asians. It is widely recognized that T2DM in East Asians is characterized primarily by β cell dysfunction, which is evident immediately after ingestion of glucose or meal, and less adiposity compared to the disease in Caucasians. These pathophysiological differences have an important impact on therapeutic approaches. Here, we revisit the pathogenesis of T2DM in light of β cell dysfunction versus insulin resistance in East Asians and discuss ethnic differences in the contributions of insulin secretion and insulin resistance, together with incretin secretin and action, to glucose intolerance.
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Affiliation(s)
- Daisuke Yabe
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka, 553-0003, Japan,
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Morales J, Merker L. Minimizing Hypoglycemia and Weight Gain with Intensive Glucose Control: Potential Benefits of a New Combination Therapy (IDegLira). Adv Ther 2015; 32:391-403. [PMID: 25962992 PMCID: PMC4449377 DOI: 10.1007/s12325-015-0208-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Indexed: 12/24/2022]
Abstract
Due to the progressive nature of type 2 diabetes (T2D), the majority of patients require increasing levels of therapy to achieve and maintain good glycemic control. At present, once patients become uncontrolled on oral antidiabetic therapies, the two primary treatment options are glucagon-like peptide-1 receptor agonists (GLP-1RAs) or basal insulin, although earlier use of GLP-1RAs has also been advocated. While both of these drug classes have proven efficacy in treating T2D, there can be limitations to their use in some patients, and resistance to further treatment intensification among both patients and physicians. More recently, treatment incorporating both a GLP-1RA and a basal insulin has been used successfully in the clinic and the first such combination product, IDegLira (insulin degludec + liraglutide), has recently been approved for use in Europe. IDegLira combines insulin degludec and the GLP-1RA liraglutide in a single injection. In both insulin-naïve and basal insulin-treated individuals with T2D, IDegLira has demonstrated greater reductions in glycated hemoglobin (HbA1c) than either of the individual components, with a low rate of hypoglycemia and weight loss. IDegLira may provide a new option for patients requiring treatment intensification but for whom increased weight or a higher risk of hypoglycemia are barriers. This article discusses the rationale behind combining these two drug classes and reviews the available clinical evidence for the efficacy and safety of IDegLira.
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Affiliation(s)
- Javier Morales
- Advanced Internal Medicine Group, Great Neck, New York, USA,
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Wong MCS, Wang HHX, Kwan MWM, Zhang DDX, Liu KQL, Chan SWM, Fan CKM, Fong BCY, Li STS, Griffiths SM. Comparative effectiveness of dipeptidyl peptidase-4 (DPP-4) inhibitors and human glucagon-like peptide-1 (GLP-1) analogue as add-on therapies to sulphonylurea among diabetes patients in the Asia-Pacific region: a systematic review. PLoS One 2014; 9:e90963. [PMID: 24614606 PMCID: PMC3948731 DOI: 10.1371/journal.pone.0090963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/06/2014] [Indexed: 01/21/2023] Open
Abstract
The prevalence of diabetes mellitus is rising globally, and it induces a substantial public health burden to the healthcare systems. Its optimal control is one of the most significant challenges faced by physicians and policy-makers. Whereas some of the established oral hypoglycaemic drug classes like biguanide, sulphonylureas, thiazolidinediones have been extensively used, the newer agents like dipeptidyl peptidase-4 (DPP-4) inhibitors and the human glucagon-like peptide-1 (GLP-1) analogues have recently emerged as suitable options due to their similar efficacy and favorable side effect profiles. These agents are widely recognized alternatives to the traditional oral hypoglycaemic agents or insulin, especially in conditions where they are contraindicated or unacceptable to patients. Many studies which evaluated their clinical effects, either alone or as add-on agents, were conducted in Western countries. There exist few reviews on their effectiveness in the Asia-Pacific region. The purpose of this systematic review is to address the comparative effectiveness of these new classes of medications as add-on therapies to sulphonylurea drugs among diabetic patients in the Asia-Pacific countries. We conducted a thorough literature search of the MEDLINE and EMBASE from the inception of these databases to August 2013, supplemented by an additional manual search using reference lists from research studies, meta-analyses and review articles as retrieved by the electronic databases. A total of nine randomized controlled trials were identified and described in this article. It was found that DPP-4 inhibitors and GLP-1 analogues were in general effective as add-on therapies to existing sulphonylurea therapies, achieving HbA1c reductions by a magnitude of 0.59-0.90% and 0.77-1.62%, respectively. Few adverse events including hypoglycaemic attacks were reported. Therefore, these two new drug classes represent novel therapies with great potential to be major therapeutic options. Future larger-scale research should be conducted among other Asia-Pacific region to evaluate their efficacy in other ethnic groups.
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Affiliation(s)
- Martin C. S. Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry H. X. Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Mandy W. M. Kwan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daisy D. X. Zhang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kirin Q. L. Liu
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sky W. M. Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen K. M. Fan
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Brian C. Y. Fong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shannon T. S. Li
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sian M. Griffiths
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
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Usui R, Yabe D, Kuwata H, Fujiwara S, Watanabe K, Hyo T, Yasuhara A, Iwasaki M, Kitatani N, Kuwabara K, Yokota K, Kurose T, Seino Y. Retrospective analysis of safety and efficacy of insulin-to-liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β-cell function. J Diabetes Investig 2013; 4:585-94. [PMID: 24843713 PMCID: PMC4020254 DOI: 10.1111/jdi.12111] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/08/2013] [Accepted: 05/06/2013] [Indexed: 02/05/2023] Open
Abstract
Aims/Introduction The safety and efficacy of insulin‐to‐liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin‐to‐liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA1c) and bodyweight in Japanese type 2 diabetes. Materials and Methods Japanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β‐cell function‐related indices, such as increment of serum C‐peptide during glucagon stimulation test (GST‐ΔCPR). HbA1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks. Results Of 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12‐week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST‐ΔCPR. Receiver–operating characteristic analysis showed that GST‐ΔCPR of 1.34 ng/mL is a cut‐off point for insulin‐to‐liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co‐administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas. Conclusions Insulin‐to‐liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST‐ΔCPR.
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Affiliation(s)
- Ryota Usui
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Daisuke Yabe
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan ; Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Hitoshi Kuwata
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Shuichi Fujiwara
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Koin Watanabe
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Takanori Hyo
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Akihiro Yasuhara
- Division of Nephrology Kansai Electric Power Hospital Osaka Japan
| | - Masahiro Iwasaki
- Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Naomi Kitatani
- Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Kyoko Kuwabara
- Division of Nursing Kansai Electric Power Hospital Osaka Japan
| | - Kayo Yokota
- Division of Nursing Kansai Electric Power Hospital Osaka Japan
| | - Takeshi Kurose
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Yutaka Seino
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
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