Comparing safety and effectiveness of liraglutide to insulin glargine after hospital discharge in patients with uncontrolled type 2 diabetes.

This study compared the safety and effectiveness of liraglutide (Victoza) to insulin glargine (Lantus) on glycemic (blood glucose) control in patients with type 2 diabetes (T2D) after hospital discharge. The authors concluded that liraglutide treatment led to improved glycemic control and greater weight loss compared to insulin glargine, after hospital discharge.

Hemoglobin A1c (HbA1c) levels are average blood glucose measures over 3 months. Discharge treatments for patients with T2D can be guided based on HbA1c levels. Although reduced HbA1c levels are possible with this approach, there is a risk of developing hypoglycemia (dangerously low blood glucose levels).

Glucagon-like peptide 1 receptor agonists (GLP-1 RA) act like gut hormones with blood glucose-lowering abilities. Studies with GLP1-RA and basal insulin showed similar improvements in HbA1c levels in patients with T2D. Patients treated with GLP1-RA had reduced hypoglycemia and less weight gain. However, it is unclear if the daily given GLP-1 RA, liraglutide, can provide a better alternative to basal insulin glargine in patients with poorly controlled T2D after hospital discharge.

This study included 273 patients with HbA1c levels of 7-10% admitted to the hospital. At hospital discharge, 136 patients received liraglutide and 137 patients received glargine insulin. HbA1c differences were determined at 12 and 26 weeks. Hypoglycemia, body weight changes and attainment of HbA1c levels of less than 7% without hypoglycemia or weight gain were assessed.

Liraglutide and glargine treatments improved blood glucose control after hospital discharge. Liraglutide resulted in 0.28% lower HbA1c levels after 12 weeks compared to glargine. It also resulted in 0.55% lower HbA1c levels compared to glargine at 26 weeks.

Fewer patients in the liraglutide group (13%) had hypoglycemia compared to the glargine group (23%). Patients in the liraglutide group lost an average of 4.8 kg at 26 weeks, while those in the glargine group gained an average of 0.6kg. Significantly more patients in the liraglutide group (48%) achieved an HbA1c level below 7% at 12 weeks compared to the glargine group (33%). 

Liraglutide treatment was associated with significantly higher rates of gastrointestinal effects such as nausea and vomiting.

The study showed that liraglutide treatment improved glycemic control and led to greater weight loss compared to glargine insulin, but resulted in more gastrointestinal effects.

The study design could bias the outcome since both researchers and patients were aware of the treatments given. The study was also short in duration (6 months). This study was funded by Novo Nordisk, the manufacturer of liraglutide.