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AACE: Complete Reversal of Type 2 Diabetes With GLP-1 Agonist

Retrospective analysis presentation shows liraglutide (LIRA) improved glycemic parameters, reduced body weight, BMI, and waist circumference in new T2 patients.

The prevalence of type 2 diabetes is increasing at an astounding rate. Many of the agents used to treat type 2 diabetes have undesirable adverse effects of hypoglycemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. They mimic the effects of the incretin hormone GLP-1, which is released from the intestine in response to food intake. Their effects include increasing insulin secretion, decreasing glucagon release, increasing satiety, and slowing gastric emptying. There are currently four approved GLP-1 receptor agonists in the United States: exenatide, liraglutide, albiglutide, and dulaglutide. A fifth agent, lixisenatide, is available in Europe. There are important pharmacodynamic, pharmacokinetic, and clinical differences of each agent.

The study authors hypothesized that because of its mechanism of action, LIRA “could address the multiple pathogeneses of T2DM,” and therefore, “should bring complete remission of T2DM in newly diagnosed patients.”

To test their hypothesis, the authors utilized electronic medical records to identify patients with new onset T2DM (duration of disease of <1 year) that were taking LIRA and metformin with or without insulin. Of note, patients lost to follow-up or those that discontinued LIRA were not included in the analysis.

A total of 71 patients with new onset T2DM were identified. At baseline, patients in the study had an average HbA1c of 8.27±2.5%, an average fasting blood sugar (FBS) of 155.8±57.0mg/dL, and an average post-prandial blood sugar (PPBS) of 179.4±85.81mg/dL. Additionally, the authors reported that the patients had an average BMI of 30.5±4.0kg/m2, an average BW of 86.34±13.36kg, and an average WC of 104.2±12.32cm.

Treatment with LIRA significantly improved all clinical parameters tested for patients with new onset T2DM. After 6 months of therapy, clinical parameters reported were as follows: HbA1c of 5.96±0.35% (P<0.0001), FBS of 105.5±13.73mg/dL (P=0.0001), and PPBS of 105.0±20.20mg/dL (P=0.0003). The retrospective analysis also found that BMI was reduced to 28.99±3.85kg/m2 (P<0.0001), BW to 81.82±12.34kg (P<0.0001), and WC to 98.08±8.94cm (P=0.0017).

The authors also reported that, “at 2 years, LIRA therapy resulted in complete remission of diabetes in 74% of subjects, requiring no medications for the treatment of diabetes.” LIRA plus metformin with or without insulin in these patients given as telemedicine integrated protocol with discontinuation over 6-8 months led to complete remission in a significant proportion of patients, the authors concluded.

This retrospective analysis demonstrated that treatment with LIRA in patients with new onset T2DM is beneficial as it significantly improves clinical parameters and can lead to weight loss. The authors added, “this observation calls for randomized controlled trials [RCTs] in a wider population, which will have a significant impact as a cost effective option for treating new onset diabetes.”

Practice Pearls:

  • Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control.
  • Benefits include positive effects on weight, blood pressure, cholesterol levels, and beta-cell function.
  • This retrospective analysis demonstrated that treatment with LIRA in patients with new onset T2DM is beneficial as it significantly improves clinical parameters and can lead to weight loss.

AACE 2017 Meeting; Drugs Context. 2015; 4: 212283.  Published online 2015 Jul 9. doi:  10.7573/dic.212283

Published in Primary Care and         1 other channel Journal Scan / Research · May 04, 2017