Liraglutide for Prevention of Diabetes
SOURCE: le Roux CW, et al. Lancet 2017;389:1399-1409.
Prevention of progression from prediabetes (pDM) to type 2 diabetes mellitus (T2DM) is quite a success story. Essentially, each antidiabetic entity that has been trialed, and some weight loss agents, has provided a substantial reduction in the risk of progression from pDM to T2DM. Untreated, clinicians could expect that (in the United States) 6-10% of untreated pDM patients per year will progress to T2DM if no intervention occurs; that number can be reduced by about 25% through several T2DM medications, including metformin, and even more by an intensive program of diet and exercise.
The newest agent to be added to the list of successful agents is liraglutide. In a study of pDM patients (n = 2,254) randomized to liraglutide or placebo and followed for up to three years, incidence of T2DM was 6% in the placebo group vs. 2% in the liraglutide group.
The study subjects in this trial were enrolled multinationally, including Europe, North and South America, Asia, Africa, and Australia. The dose of liraglutide used would be regarded as the “weight-loss dose”; that is, liraglutide under the trade name of Victoza is prescribed for treatment of T2DM up to 1.8 mg/day, but under the trade name of Saxenda is prescribed at 3 mg/day for the treatment of obesity. As would be anticipated, liraglutide treatment produced a significant weight loss: approximately 5 kg greater than the placebo group.
Currently, the most popular pharmacologic treatment for prevention of T2DM in patients with prediabetes is metformin. Several other agents have been shown to produce similar effects, although their use would be off-label.
Liraglutide is the newest agent to be added to the list of successful agents for combating diabetes.
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