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Liraglutide Reducing Postprandial Hyperglycemia Using Closed Loop System

Once-daily injection of liraglutide in closed-loop setting effective in decreasing postprandial hyperglycemia, hyperglucagonemia and insulin requirements….

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Jeniece Trast, RN, of the Children’s Hospital at Montefiore in Bronx, New York, believes that the limitations of the closed loop system is due to the current algorithm used that causes the closed loop system to not respond in a timely manner to glucose absorption. To combat postprandial hyperglycemia without causing hypoglycemia, Trast and her colleagues hypothesized that the use of liraglutide with a closed loop system will suppress postprandial hypoglycemia.

A small randomized, open-label, crossover design study was done with fifteen patients, ages 18-40 with type 1 diabetes, using an external physiologic insulin delivery closed loop system. Researchers randomly assigned patients to two overnight visits, with study A having insulin treatment and study B having treatment with insulin and liraglutide 1.2mg before dinner on day 1.

The results of the study indicated that the glycemic profile was significantly better in the insulin plus liraglutide arm, as compared with the insulin only arm (P<.05). Insulin plus liraglutide was also associated with overall delayed time to peak blood glucose levels without significant postprandial hypoglycemia, as compared with insulin only in patients with type 1 diabetes (P<.0001).

Initiating liraglutide with a closed loop system will lower postprandial hyperglycemia. The researchers concluded that, “This study found that closed loop with once daily liraglutide decreased postprandial hyperglycemia and postprandial glucagonemia and delayed time to and magnitude of peak blood glucose levels with no significant hypoglycemia after meals.” “When using liraglutide, insulin values were significantly lower after meals and we saw a decrease in peak after meal times. We also saw a significant decrease in glucagon levels after meal times.”

Practice Pearls:

  • In this study, liraglutide and insulin delayed blood glucose levels without causing hypoglycemia.
  • Future trials are needed to confirm the findings of the study.

Trast J et al. Abstract 220-OR: Liraglutide Reduces Postprandial Hyperglycemia in the Closed Loop System. Presented at: American Diabetes Association (ADA) 75th Scientific Sessions; June 5-9, 2015; Boston.