Quality of life in obese patients with type 2 diabetes improved.
Obesity is one of the main factors that causes type 2 diabetes. Many obese patients with type 2 diabetes have sleep disturbance at night, or they may need excessive daytime sleep. Sleep disturbance is commonly considered to impair glucose metabolism and generate physical distress. Since the quality of sleep has great impact on the management of type 2 diabetes, the treatment of the sleep disorder should play an important role in diabetes care. Therefore, researchers wanted to examine the potential benefit of diabetic medication such as liraglutide on the treatment of excess daytime sleepiness.
Liraglutide, which is a long-acting glucagon-like peptide-1 receptor agonist, helps diabetic patients control their glycemic level. It was approved by the U.S. Food and Drug Administration in January 2010. A new study published in BMC Endocrine Disorder in December 2015 accessed the association between liraglutide treatment and the reduction in excessive daytime sleepiness in obese patients with type 2 diabetes.
Researcher Fernando Gomez-Peralta and his colleagues conducted a single-center retrospective study of 158 obese patients with BMIs greater than 30 kg/m2 at the Hospital General de Segovia in Spain. All participants with type 2 diabetes had been on liraglutide for at least 3 months before being included in the study. They were started with the dose of 0.6mg/day, and later the dose was increased over one week to 1.2 mg/day. The exclusion criteria included bariatric surgery or having greater than 5% of weight loss within the previous 6 months. Researchers analyzed data by glucose control measurements, metabolic parameters like cholesterol profiles, and anthropometric parameters, which included height, weight, BMI, waist circumference, and body composition. The clinical impact of excess daytime sleepiness was measured by the epworth sleepiness scales.
In this 12-week study, a total of 163 participants were included in the results. Researchers found significant reduction in the epworth sleepiness scales score from baseline at month 1 (6.3+/- 4.6 vs 4.9 +/- 3.9, p<0.001) and month 3 (5.7+/- 4.4 vs 4.2 +/- 3.6, p<0.001), respectively. It was also found that HbA1c levels and fasting plasma glucose improved with p value less than 0.001. Other than that, significant improvement in all areas was observed after 3 months of treatment with liraglutide, such as body weight, BMI, waist circumferences, triglycerides, and total cholesterol.
Other than this study, another study published in the Journal of Sleep Research in June 2012 also showed another GLP agonist called exenatide could improve excessive daytime sleepiness and wakefulness in obese patients with type 2 diabetes without obstructive sleep apnea. In this study, they also found exenatide had no effect on the depression score and driving performance. It was concluded from this study that this was the first interventional study to investigate the role of exenatide in modulating daytime sleepiness and driving performance in obese patients with type 2 diabetes without OSA.
We showed that exenatide improved EDS (excessive daytime sleepiness) significantly, independent of HbA1c reduction. The mechanisms for these observations are unknown, and may be explained only partially by weight reduction. We hypothesized, however, that the accumulating evidence on the role of hypothalamic nuclei in regulating sleep and wakefulness, as well as the well-recognized pleiotropic effects of exenatide in conjunction with the presence of GLP-1 receptors in the hypothalamus, would suggest a direct effect of exenatide in affecting sleepiness.
Many studies had proven liraglutide could reduce body weight in people with type 2 diabetes. However, researchers stated this was the first study to explore the relationship between liraglutide-induced weight reduction and reduction of excess daytime sleepiness in obese patient with type 2 diabetes. The study also discussed liraglutide-induced weight reduction caused by decreasing appetite and reducing fat intake, which led to improve epworth sleepiness scales score. Researchers mentioned diabetic care should include not only the control of blood glucose levels, but also the achievement of metabolic improvement, such as weight loss and good lipid profiles. On the other hand, the limitations of this study included no interventions in participants other than physician’s routine, lacking data from sleep studies, and lacking of a comparator group.
Authors believed liraglutide could benefit obese patients with type 2 diabetes by helping them lose weight and reduce excess daytime sleepiness, but more studies like a random clinical trial need to prove these findings.
- A single-center retrospective study of liraglutide accessed the reduction of excess daytime sleepiness obese patients with type 2 diabetes.
- The results showed liraglutide achieved a greater epworth sleepiness scales score reduction in type 2 diabetes patients.
- Since this was observation study with limitations, more research is needed to prove these findings.
Gomez-Peralta F, et al. “An association between liraglutide treatment and reduction in excessive daytime sleepiness in obese subjects with type 2 diabetes.” BMC Endocrine Disorders. 2015 December.
Idris I, et al. “Exenatide improves excessive daytime sleepiness and wakefulness in obese patients with type 2 diabetes without obstructive sleep apnoea.” Journal of Sleep Research. 2012 June.