The use of liraglutide, a GLP-1 agonist, in obese people with type 1 diabetes


  • Syed MR Gillani Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.
  • Baldev M Singh Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK.



Aims: Optimisation of glycaemic control in type 1 diabetes often results in unwanted weight gain. glucagon-like peptide-1 (GLP-1) agonist use is associated with weight reduction in type 2 diabetes but its use in type 1 diabetes is little studied.

Methods: We developed a protocol for GLP-1 use in people with type 1 diabetes and obesity in which liraglutide was initiated and up-titrated whilst insulin doses were simultaneously titrated according to glycaemic parameters.

Results: Of 15 patients offered treatment, 8 proceeded. Baseline parameters were (n=8, mean + SD): (age 50 ± 6 years, BMI 40.4 ± 5.5 kg/m2, weight 123.0 ± 23.9 kg, HbA1c 8.5 ± 1.7%, total daily insulin dose 131 ± 112 units/day. By intention to treat analysis (n=8, 12 months), at 3, 6 and 12 months compared to baseline, weight loss was 6.8 ± 4.1 kg, 10.0 ± 5.6 kg and 8.9 ± 8.4 kg (p=0.026). The reductions in insulin dosage were significant over 6 months (n=8, p=0.045) or when analysing only those who completed 12 months of liraglutide therapy (n=6, p=0.044).

Conclusions: GLP-1 agonist use in patients with type 1 diabetes may be advantageous where weight reduction becomes both a constraint and a therapeutic objective.


The DCCT Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.

Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes--causes, effects and coping strategies. Diab Obes Metab 2007;9:799-812.

Purnell J, Zinman B, Brunzell J. The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus. Circulation 2013;127:157-9.

Brinkworth GD, Wycherley TP, Noakes M, et al. Reductions in blood pressure following energy restriction for weight loss do not rebound after re-establishment of energy balance in overweight and obese subjects. Clin Exp Hypertens 2008;30:385-96.

Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 2005;353:2111-20.

Czupryniak L, Strzelczyk J, Cypryk K, et al. Gastric bypass surgery in severely obese type 1 diabetic patients. Diab Care 2004;27:2561-2.

Näslund E, Kral JG. Impact of Gastric bypass surgery on gut hormones and glucose homeostasis in type 2 diabetes. Diab Care 2006;55:92-7.

Horton E, Silberman C, Davis K, et al. Weight loss, glycaemic control, and changes in cardiovascular biomarkers in patients with type 2 diabetes receiving incretin therapies or insulin in a large cohort database. Diab Care 2010;33:1759-65.

Lisa MN, Robert FK. Emerging role of GLP-1 receptor agonists in the treatment of obesity. Diab Met Synd Obes: Targets and Therapy 2010;3 263-73.

Astrup A, Carraro R, Finer N, et al. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analogue, Liraglutide. Int J Obes 2012;36:843-54.

Varanasi A, Bellini N, Rawal D, et al. Liraglutide as additional treatment for type 1 diabetes. Eur J Endocrinol 2011;165:77-84.

Kielgast U, Krarup T, Holst JJ, et al. Four weeks of treatment with liraglutide reduces insulin dose without loss of glycemic control in type 1 diabetic patients with and without residual beta-cell function. Diab Care 2011;34:1463-8.

Kuhadiya N, Malik R, Bellini N, et al. Long-term follow-up of patients with type 1 diabetes on liraglutide and the effect of liraglutide as additional treatment in obese patients with type 1 diabetes. Endocr Review 2012;33; (03 meeting abstracts): OR 17-1,, Last accessed 28/4/13.

Lovshin JA, Drucker DJ. Incretin-based therapies for type 2 diabetes mellitus. Nature Rev: Endocrinol 2009;5:262-9.

Flint A, Raben A, Astrup A, et al. Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. J Clin Invest 1998;101:515-20.

Egan JM, Meneilly GS, Habener JF, et al. Glucagon-like peptide-1 augments insulin-mediated glucose uptake in the obese state. JCEM 87:3768-73.

Wettergen A, Scholdager B, Mortensen PE, et al. Truncated GLP-1 (proglucagon 87-107amide) inhibits gastric and pancreatic functions in man. Dig Dis Sci 1993;38:665-73.

Madsbad S. Liraglutide Effect and Action in Diabetes (LEADTM) trial. Expert Rev Endocrinol Metab 2009;4:119-29.

Nayak UA, Govindan J, Baskar V, et al. Exenatide therapy in insulin treated type 2 diabetes and obesity. QJM 2010;103:687-94.

Creutzfeldt WO, Kleine N, Willms B, et al. Glucagonostatic actions and reduction of fasting hyperglycemia by exogenous glucagon-like peptide I(7-36) amide in type I diabetic patients. Diab Care 1996;19:580-6.

Gutniak M, Orskov C, Hoist JJ, et al. Antidiabetogenic effect of glucagon-like peptide-l (7-36)amide in normal subjects and patients with diabetes. N Engl J Med 1992;326:1316-22.

“Liraglutide as Additional Treatment in Patients With Type 1 Diabetes Mellitus”, Clinical Trials US National Institute of Health,, Last accessed 08/05/13

“The efficacy and safety of liraglutide as adjunct therapy to insulin in the treatment of type 1 diabetes”, registration: NCT01836523,, Last accessed 08/05/13.






Learning from practice