Obesity contributes to the pathogenesis of type 2 diabetes (T2DM) and cardiovascular disease. A modest weight loss of 5-10% can have significant impact on glucose control, medications use and patients' functionality and quality of life. Until recently, only orlistat was approved in Europe for weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been shown to improve glycaemia in patients with T2DM with an added benefit of weight reduction. However, the weight loss varies considerably within class and between individuals with up to 30% of patients not losing weight with GLP-1 RA treatment.GLP-1 RAs were placed as a possible second-line treatment as an add on to metformin by the latest ADA/EASD joint guidelines while NICE placed them as third-line agents for patients with T2DM and a body mass index (BMI) ≥35kg/m 2 and inadequate glycaemic control. NICE recommended that GLP-1 RAs can be used in patients with BMI <35kg/m 2 in ethnic groups, when used as an alternative to insulin where insulin treatment has vocational implications, or if weight loss would be beneficial for other medical reasons. A GLP-1 RA (Saxenda) has recently been approved by the FDA and EMA as a weight loss treatment in patients without T2DM.This paper aims to review the impact of GLP-1 RA treatment on weight loss in patients with and without diabetes, from clinical trials as well as real-life UK data from the ABCD nationwide audits, and also discuss the future role of GLP-1 RAs.
IntroductionTo assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal–bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness.MethodsPatients with T1D who were aged ≥ 18 years, were on a basal–bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness.ResultsSix months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0–9.3)% [70 (64–78) mmol/mol] to 8.4 (7.9–8.9)% [68 (63–74) mmol/mol]; p < 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7–45.0) to 25.5 (14.0–30.2) units; p < 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs.ConclusionIn patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings.FundingNovo Nordisk.
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