The use of GLP-1 agonist therapy, liraglutide, is associated with significant weight loss in morbidly obese people without diabetes

Authors

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

DOI:

https://doi.org/10.15277/bjdvd.2015.011

Abstract

Introduction: In obesity, bariatric surgery is effective but carries morbidity and mortality risks. In type 2 diabetes, glucagon-like peptide-1 (GLP-1) agonist therapy results in weight reduction. Randomised controlled trials show efficacy in the non-diabetes obese population. Thus we have audited GLP-1 agonist use for weight reduction in morbidly obese people without diabetes.

Methods: A protocol for GLP-1 use in non-diabetes obesity (body mass index >35 kg/m2) was agreed with local clinical governance committees. After liraglutide initiation, follow up was monthly, and the dose was up-titrated to a maximal 3 mg daily if indicated.

Results: Of 34 people offered treatment, 22 proceeded (age 42 ± 14 years, 17 females, 16 White Caucasians) and 14 completed 12 months of treatment. Absolute weight fell significantly from a baseline of 127 ± 19 kg (n=22) to 121 ± 19 kg (n=22), 119 ± 21 kg (n=21) and 110 ± 15 kg (n=14) kg at 3, 6 and 12 months respectively (all p<0.001 from baseline) amounting to -5.3 ± 4.4 kg, -7.4 ± 7.7 kg and -12.1± 9.6 kg at 3, 6 and 12 months respectively (all p<0.001 from baseline).

Conclusions: GLP-1 agonist therapy may play a significant role in people who have failed other weight loss options and are potential candidates for bariatric surgery.

References

Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 2003;13:329-30. http://dx.doi.org/10.1381/096089203765887598

Statistics on Obesity, Physical Activity and Diet: England 2014; available at: http://www.hscic.gov.uk/catalogue/PUB13648/Obes-phys-acti-diet-eng-2014-rep.pdf

Waterland RA, Garza C. Potential mechanisms of metabolic imprinting that lead to chronic disease. Am J Clin Nutr 1999;69(2):179-97.

Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: A randomized trial. JAMA 2005; 293:43-53. http://dx.doi.org/10.1001/jama.293.1.43

Brinkworth GD, Wycherley TP, Noakes M, Clifton PM. 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. http://dx.doi.org/10.1080/10641960802275734

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. http://dx.doi.org/10.1056/NEJMoa050156

Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 2006;29:2102-07. http://dx.doi.org/10.2337/dc06-0560

North American Association for the Study of Obesity and the National Heart, Lung, and Blood Institute. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Md: National Institutes of Health; 2000. NIH publication 00-4084

Brolin RE. Bariatric surgery and long-term control of morbid obesity; JAMA 2002;288(22):2793-6. http://dx.doi.org/10.1001/jama.288.22.2793

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37. http://dx.doi.org/10.1001/jama.292.14.1724

Buchwald H. A bariatric surgery algorithm. Obes Surg 2002;12:733-46. http://dx.doi.org/10.1381/096089202320995484

Hermann C, Goke R, Richter G, Fehmann H, Arnold R, Goke B. Glucagon-like peptide-1 and glucose-dependent insulin-releasing polypeptide plasma levels in response to nutrients. Digestion 1995;56:117-26. http://dx.doi.org/10.1159/000201231

Zander M, Madsbad S, Madsen JL, Holst JJ. Effect of 6-week course of glucagon-like peptide 1 on glycaemic control, insulin sensitivity, and [beta]-cell function in type 2 diabetes: A parallel-group study. Lancet 2002;359:824-30. http://dx.doi.org/10.1016/S0140-6736(02)07952-7

Garber A J. Long-acting glucagon-like peptide 1 receptor agonists; a review of their efficacy and tolerability. Diabetes Care 2011;34(Supplement 2):S279-S284. http://dx.doi.org/10.2337/dc11-s231

Vilsbøll T, Christensen M, Junker AE, Knop FK, Gluud LL. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ 2012;344:d7771. http://dx.doi.org/10.1136/bmj.d7771

Baggio LL, Drucker DJ. Biology of incretins: GLP-1 and GIP. Gastroenterology 2007;132:2131-57. http://dx.doi.org/10.1053/j.gastro.2007.03.054

Nauck MA, Kleine N, Orskov C, Holst JJ, Willms B, Creutzfeldt W. Normalization of fasting hyperglycaemia by exogenous glucagon-like peptide 1 (7-36 amide) in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1993;36:741-4. pmid:8405741

Astrup A, Rössner S, Van Gaal L, et al. Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet 2009;374:1606-16. http://dx.doi.org/10.1016/S0140-6736(09)61375-1

Rosenstock J, Klaff LJ, Schwartz S, et al. Effects of exenatide and lifestyle modification on body weight and glucose tolerance in obese subjects with and without pre-diabetes. Diabetes Care 2010;33:1173-5. http://dx.doi.org/10.2337/dc09-1203

Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: The SCALE Maintenance randomized study. Int J Obes 2013;37:1443-51. http://dx.doi.org/10.1038/ijo.2013.120

Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f5934. http://dx.doi.org/10.1136/bmj.f5934

Maggard M, Shugarman L, Suttorp M, et al: Meta-analysis: surgical treatment for obesity. Ann Intern Med 2005;142:547-59. http://dx.doi.org/10.7326/0003-4819-142-7-200504050-00013

Puzziferri N, Austrheim IT, Wolfe BM, Wilson SE, Hguyen NT. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg 2006;243:181-8. http://dx.doi.org/10.1097/01.sla.0000197381.01214.76

Favretti F, Segato G, Ashton D, et al. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg 2007;17:168-75. http://dx.doi.org/10.1007/s11695-007-9043-0

Goodney PP, Siewers AE, Stukel TA, et al. Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 2002;195:219-27. http://dx.doi.org/10.1016/S1072-7515(02)01228-0

Flum DR, Salem L, Elrod JA, Dellinger LP, Cheadle A, Chan L. Early mortality among medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294:1903-08. http://dx.doi.org/10.1001/jama.294.15.1903

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 (Lond) 2012;36(6):843-54. http://dx.doi.org/10.1038/ijo.2011.158

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Published

2015-06-08

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Learning from practice