Mikhail NE.
Endocrinology Division, Olive-View-UCLA Medical Center.
Objective: To evaluate liraglutide as antidiabetic agent.Methods: Review of English literature from 1985 to April 2010 using data from MEDLINE.Results: Liraglutide is a GLP-1-receptor analog that stimulates insulin secretion, reduces postprandial glucagon release, causes mild delay in gastric emptying, and may slightly decrease appetite. Mean reductions in HbA1c levels with liraglutide ranges from 1.0 to 1.5% compared with baseline and 1.1 and 1.3% compared with placebo. Head-to-head trials suggest that liraglutide may be more effective than glimepiride, rosiglitazone, insulin glargine and exenatide. However, some of the previous trials are limited by using submaximal doses of comparator and the open-label design. The use of liraglutide is associated with an average weight loss of 0.2 to 3.2 kg relative to baseline and 0.1 to 2.6 kg relative to placebo. Hypoglycemia is generally mild, but its incidence and severity markedly increase in conjunction with SUs. GI adverse effects such as nausea, diarrhea or vomiting occur in 44-56% of patients who received liraglutide versus 17-19% with placebo. Five to 15% of liraglutide-treated patients withdrew prematurely from trials compared with 3-5% with placebo, mainly due to GI adverse effects.Conclusion: The 2 main advantages of liraglutide are mild degrees of weight loss and hypoglycemia. However, the frequent incidence of GI adverse effects, requirement of subcutaneous injection once daily, and lack of long-term efficacy and safety data are important limitations. Liraglutide may be a useful add-on therapy in patients with type 2 diabetes uncontrolled on metformin, when hypoglycemia and/or weight gain are major concerns.
PMID: 20439238
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