Liraglutide use in Type 1 diabetes patients offers multiple benefits
By Lisa Foster-McNulty, MSN, RN, CDE
Raju Panta, MD and colleagues from the State University of New York at Buffalo reviewed data and performed a meta-analysis. Following 12 weeks of treatment with liraglutide, Type 1 patients had a 0.29% decrease in A1c as compared to placebo. Panta and colleagues reported that this was the initial systematic review and meta-analysis of the literature on the use of GLP-1RA in patients with Type 1.
Panta said that his group wanted to look at safety and efficacy outcomes for Type 1s, pooling data from previous phase III clinical trials. They used a random-effects model to evaluate change in A1c, weight, basal insulin, bolus insulin, and adverse events in Type 1 patients on GLP-1RA medication. Their analysis examined 212 patients, after they conducted a literature review from databases which included PubMed, Cochrane Central, and Embase.
A1c was not the only outcome that improved. Use of liraglutide for 12 weeks in Type 1 patients was associated with a 4.39 unit decrease in daily bolus insulin, and a 2.55 unit reduction in the daily basal insulin dose. Compared to placebo, patients had a weight loss of 10.05 lbs (4.56 kg).
Based upon their previous clinical observations, the researchers weren’t surprised at the improvements per se, but the amount of improvement in 12 weeks exceeded their expectations. While an A1c decrease of 0.29% isn’t a lot compared to placebo, it did end up being statistically significant. The researchers believe that the decrease in A1c came from reduced post-meal glucagon levels in the liraglutide group, as glucagon is made by the alpha cells of the pancreas.
Compared to placebo, liraglutide users experienced a significant increase in nausea. However, this did not worsen the prevalence of vomiting.
With research studies, it’s common to see a recommendation that more research is needed. Panta’s group believes that certain individuals with Type 1 (for example, those who are also obese) might derive significant benefit from using GLP-1RAs. They also thought it would be beneficial to conduct future research to analyze BG variability in this group.
While progress has been made in treating Type 1 patients (think BG monitoring, use of insulin pumps and insulin pens), many people with Type 1 don’t get their A1c down to target. Insulin and Pramlintide are the only medications approved for use in this population. Use of GLP-1RA in Type 1 patients is done off-label at the present time. We think it would be great if there were more approved therapies for Type 1 diabetes, especially since not all providers are comfortable prescribing off-label. The more tools with proven safety that we have at our disposal, the better!