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Encouraging news for Type 1s interested in using a GLP 1 med with insulin

By Lisa Foster-McNulty, MSN, RN, CDE

Traditionally, treatment of type 1 diabetes has been all about insulin. Symlin is the only other medication approved to be used in conjunction with insulin to treat Type 1. We’ve been seeing more and more research lately on the use of Glucagon-like peptide-1 receptor agonist (GLP-1 RA) drugs as a treatment adjunct for Type 1, and the news from this latest study is encouraging.

According to research recently published in Diabetes, Obesity, and Metabolism, 20 patients with Type 1 diabetes who were over the age of 18 and with an A1c of at least 8% were enrolled from June of 2013 to October of 2014 in a 12 week long, randomized, double-blinded, placebo-controlled research study. They were randomly assigned (1:1) to the GLP-1 RA liraglutide (Victoza) 1.2 mg daily, or to placebo, as an add-on to insulin. GLP-1 RAs are known to inhibit the secretion of glucagon and to delay gastric (stomach) emptying. They can also hinder recovery from hypoglycemia. This study looked at the effect that liraglutide has on the response of counter-regulatory hormones and gastric emptying (GE) during hypoglycemia in participants with Type 1 diabetes.
Prior to treatment, and at the end of treatment, a hypoglycemic “clamp” (with a target BG of 2.5 mmol/L or 45 mg/dl) was implemented, and then a liquid meal was given. The primary endpoint of the study was change in GE rate. The secondary endpoints of the study were changes in blood glucose recovery, counter-regulatory hormones, pancreatic polypeptide, GLP-1, blood pressure, and heart rate.

Following 12 weeks of treatment , changes in GE rates didn’t differ significantly between the two study groups. The secondary endpoint responses were similar, as well, with the exception of heart rate. Heart rate did increase with liraglutide from 69 +/- 4 to 80 +/- 5 beats per minute.
The researchers came to the conclusion that following an episode of hypoglycemia, Liraglutide doesn’t compromise blood sugar recovery, GE rate, or counter-regulatory hormone responses in individuals with Type 1 diabetes. They found no treatment-related safety issues.

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