Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

Abstract

Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.

Effectiveness and safety of new oral and injectable agents for in-hospital management of type 2 diabetes in general wards: Systematic review and meta-analysis

“…Table 1 presents the population characteristics of each study. Three of the RCT employed GLP1Ra with and without insulin in sliding scale as intervention (20)(21)(22)26), and four evaluated DPP4i with and without insulin in sliding scale (16)(17)(18)(19). Two RCT used DPP4i with insulin in sliding scale as an intervention (23,25), and only one study used SGLT2i with insulin in sliding scale (24).…”

Short-term Glycemic Variability and Its Association With Macrovascular and Microvascular Complications in Patients With Diabetes

“…107 In patients with ACS, suboptimal administration of liraglutide (0.6 mg daily) during hospitalization decreased more CV, SD, and MAGE compared with insulin glargine, despite the fact that this difference was not statistically significant. 108 Pharmacokinetic (PK) and pharmacodynamic (PD) profiles of insulin glargine-300 (Gla-300) were steadier than those of insulin glargine 100 (Gla-100), creating in this way a more stable glycemic status. 109 Propitious differences in PK/PD profiles and endogenous glucose production have been recorded with the evening-dose of Gla-300, and as a consequence, patients demonstrated lower nocturnal insulin activity, greater insulin activity in the afternoon, and lower intraday PK/PD variability.…”