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Liraglutide Hospital Discharge Trial
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In this randomized clinical trial, initiation of liraglutide was compared with that of basal insulin at hospital discharge in individuals with type 2 diabetes.
- Compared with initiation of basal insulin at discharge, liraglutide was associated with an additional −0.55% HbA1c lowering at 6 months, lower hypoglycaemia frequency, and greater mean weight loss (−4.7 kg vs −0.6 kg; P < .001).
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Few studies have focused on pharmacologic diabetes therapy adjustments at hospital discharge. This randomized clinical trial compared a GLP-1 receptor analog with basal insulin at hospital discharge in patients with uncontrolled type 2 diabetes.
METHODS
A total of 273 patients with HbA1c 7-10% were randomised to liraglutide (n = 136) or glargine (n = 137) at hospital discharge. The primary endpoint was difference in HbA1c at 12 and 26 weeks. Secondary endpoints included hypoglycaemia, changes in body weight, and achievement of HbA1c <7% without hypoglycaemia or weight gain.
RESULTS
Between-group HbA1c difference at 12 weeks and 26 weeks was -0.28%, 95%CI: (-0.64, 0.09), and 26 weeks was -0.55%, 95%CI (-1.01, -0.09) in favour of liraglutide. Liraglutide treatment resulted in lower frequency of hypoglycaemia <3.9 mmol/L (13% vs 23% p = 0.04), but there was no difference in the rate of clinically significant hypoglycaemia <3.0 mmol/L. Compared to glargine, liraglutide treatment was associated with greater weight loss at 26 weeks (-4.7 ± 7.7 Kg vs. -0.6 ± 11.5 kg, p < 0.001) and in the proportion of patients with HbA1c <7% without hypoglycaemia was 48% vs 33% (p = 0.05) at 12 weeks and 45% vs 33% (p = 0.14) at 26 weeks in liraglutide vs glargine insulin. The proportion of patients with HbA1c <7% without hypoglycaemia and no weight gain were higher with liraglutide at 12 (41% vs 24%, p = 0.005) and 26 weeks (39% vs 22%, p = 0.014). The incidence of gastrointestinal adverse events was higher with liraglutide than with glargine (p < 0.001).
CONCLUSION
Compared to insulin glargine, treatment with liraglutide at hospital discharge resulted in better glycaemic control and greater weight loss, but increased gastrointestinal adverse events.
Additional Info
Disclosure statements are available on the authors' profiles:
Liraglutide Hospital Discharge Trial: A Randomized Controlled Trial Comparing the Safety and Efficacy of Liraglutide Versus Glargine Insulin for the Management of Patients With Type 2 Diabetes After Hospital Discharge
Diabetes Obes Metab 2021 Feb 16;[EPub Ahead of Print], FJ Pasquel, MA Urrutia, S Cardona, KW Zamudio Coronado, B Albury, MC Perez-Guzman, RJ Galindo, A Chaudhuri, G Iacobellis, J Palacios, JM Farias, P Gomez, I Anzola, P Vellanki, M Fayfman, GM Davis, AL Migdal, L Peng, GE UmpierrezFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Adherence to insulin therapy is generally poor, but many individuals with diabetes require initiation or intensification of diabetes therapy upon hospital discharge. In this randomized clinical trial, non–critically ill hospitalized patients with type 2 diabetes (HbA1c >7%–10%; on any diabetes therapy including insulin but excluding recent GLP1RA use) were randomized to receive mono- or add-on therapy with liraglutide versus insulin glargine at hospital discharge. A greater reduction in HbA1c was found in patients on liraglutide (~1.2%) versus glargine (~0.7%) at 26 weeks, with a clinically (and statistically) significant difference in HbA1c of 0.55% at 26 weeks. More patients on liraglutide versus glargine were able to achieve HbA1c <7% without hypoglycemia or weight gain at 12 weeks (41% vs 24%, respectively) and 26 weeks. A total of 9 (~7%) of the individuals in the liraglutide group required the addition of insulin, but this does not significantly lessen the study’s conclusions.
The benefits of liraglutide include simpler titration, cardiovascular, and renal benefits, and HbA1c-lowering with minimal hypoglycemia or weight gain. However, barriers to starting GLP1RAs on discharge include cost, potential need for prior authorization delaying initiation immediately post discharge, and adverse gastrointestinal side effects leading to treatment discontinuation. Furthermore, in this trial, approximately 40% of study participants dropped out or were lost to follow-up, which unfortunately makes it difficult to draw definitive conclusions. Nevertheless, this well-conducted randomized study provides data supporting the potential use of liraglutide instead of basal insulin at hospital discharge in carefully selected patients with type 2 diabetes.