Insulin treatment and longer diabetes duration both predict poorer glycaemic response to liraglutide treatment in type 2 diabetes: the Association of British Clinical Diabetologists Nationwide Liraglutide Audit

Ken Y Thong, Barbara M Mcgowan, Thein Htay, Andrew Pernet, Chris Kelly, Chinnadorai Rajeswaran, Jill Howell, Catriona Duncan, Berit Inkster, Linda Buchanan, Saiful Kassim, Rahul Nayer, Nicholas D Barwell, Christopher Walton, Robert EJ Ryder, ABCD Nationwide Liraglutide Audit contributors

Abstract


Background: Liraglutide may be less effective in patients with more advanced type 2 diabetes. This study from the Association of British Clinical Diabetologists Nationwide Liraglutide Audit analysed changes in HbA1c of patients after 26 weeks of treatment with liraglutide 1.2 mg, stratified according to the intensity of their background diabetes therapy, or according to their duration of diabetes.

Methods: Patients using liraglutide as add-on therapy were stratified for receipt to one, two or three oral antidiabetic agents (OADs) or insulin (± OAD), or for diabetes duration of 0–5 years, 6–10 years, or >10 years. Changes in HbA1c were compared across groups after adjusting for baseline HbA1c.

Results: After exclusions to standardise comparisons, 937 patients with background diabetes treatment and 802 patients with recorded diabetes duration were analysed. Least-squares adjusted mean changes in HbA1c (± SEM) were –1.8% ± 0.1 for 135 patients on one OAD, –1.7% ± 0.1 for 284 patients on two OADs,–1.9% ± 0.1 for 94 patients on three OADs (n=94) and –1.0% ± 0.1 for 424 patients receiving insulin. HbA1c changes did not differ significantly between OAD groups, but all OAD groups had greater HbA1c reductions compared with the insulin group (all p<0.00001). Adjusted mean HbA1c changes were –2.0% ± 0.1 for patients with diabetes duration 0–5 years (n=147, p<0.05 vs. longer diabetes durations), –1.6% ± 0.1 for 6–10 years (n=256), and –1.2% ± 0.1 for >10 years (n=399).

Conclusion: The need for insulin and long diabetes duration, but not the number of OADs taken, predicted a smaller treatment response to liraglutide.

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References


Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012;55:1577-96. http://dx.doi.org/10.1007/s00125-012-2534-0

Novo Nordisk. Liraglutide Summary of Product Characteristics (Europe). Available at http://www.medicines.org.uk/emc/medicine/21986 (accessed May 2015).

Victoza® (liraglutide) US Prescribing Information. Available at www.victoza.com (accessed October 2015).

Ratner R, Brett J, Khutoryansky N, Aroda VR. Identifying predictors of response to liraglutide in type 2 diabetes using recursive partitioning analysis. Diabetologia 2012 (55 Suppl 1):S332. http://dx.doi.org/10.1007/s00125-012-2688-9

Garber A, Matthews DR, Zinman B, et al. The impact of disease stage, indicated by number of previous oral antidiabetic agents, on the clinical benefits of liraglutide in the treatment of type 2 diabetes. Diabetologia 2011;54 (Suppl1):S320. http://dx.doi.org/10.1007/s00125-011-2276-4

Penfornis A, Gourdy P, Martinez L, et al. Diabetes duration and background diabetes therapies in predicting liraglutide treatment response: data from the post-marketing EVIDENCE study. Diabetologia 2013;56:(Suppl1):S356. http://dx.doi.org/10.1007/s00125-013-3012-z

Association of British Clinical Diabetologists. ABCD Nationwide Liraglutide Audit. Available at http://www.diabetologists-abcd.org.uk/GLP1_Audits/Liraglutide_Audit.htm (accessed October 2015).

Ligthelm RJ, Borzì V, Gumprecht J, et al. Importance of observational studies in clinical practice. Clin Ther 2007;29 (Themed issue):1284-92. http://dx.doi.org/10.1016/j.clinthera.2007.07.004

Thong KY, Jose B, Sukumar N, et al. Safety, efficacy and tolerability of exenatide in combination with insulin in the Association of British Clinical Diabetologists nationwide exenatide audit. Diabetes Obes Metab 2011;13:703-10. http://dx.doi.org/10.1111/j.1463-1326.2011.01393.x

Nauck M, Frid A, Hermansen K, et al. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care 2009;32:84-90. http://dx.doi.org/10.2337/dc08-1355

Kahn SE, Haffner SM, Heise MA, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006;355: 2427-2443. http://dx.doi.org/10.1056/NEJMoa066224

Kozawa J, Inoue K, Iwamoto R, et al. Liraglutide is effective in type 2 diabetic patients with sustained endogenous insulin-secreting capacity. J Diabetes Investig 2012;3:294-7. http://dx.doi.org/10.1111/j.2040-1124.2011.00168.x

Rosenstock TR, Shenouda SK, Bergenstal RM, et al. Baseline factors associated with glycaemic control and weight loss when exenatide twice daily is added to optimized insulin glargine in patients with type 2 diabetes. Diabetes Care 2012;35:955-958. http://dx.doi.org/10.2337/dc11-1434

Thong KY, McDonald TJ, Hattersley AT, et al. The association between postprandial urinary C-peptide creatinine ratio and the treatment response to liraglutide: a multi-centre observational study. Diabet Med 2014;31:403-11. http://dx.doi.org/10.1111/dme.12367

Usui R, Yabe D, Kuwata H, et al. 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. http://dx.doi.org/10.1111/jdi.12111

Araki H, Tanaka Y, Yoshida S, et al. Oral glucose-stimulated serum C- peptide predicts successful switching from insulin therapy to liraglutide monotherapy in Japanese patients with type 2 diabetes and renal impairment. J Diabetes Investig 2014;5:435-41. http://dx.doi.org/10.1111/jdi.12169

Meier JJ, Rosenstock J, Hincelin-Méry A, et al. Contrasting effects of lixisenatide and liraglutide on postprandial glycemic control, gastric emptying, and safety parameters in patients with type 2 diabetes on optimized insulin glargine with or without metformin: a randomized, open-label trial. Diabetes Care 2015;38:1263-73. http://dx.doi.org/10.2337/dc14-1984

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. http://dx.doi.org/10.1007/s12325-015-0208-2




DOI: https://doi.org/10.15277/bjdvd.2015.046

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