Retrospective analysis of safety and efficacy of insulin‐to‐liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β‐cell function

Abstract

Aims/IntroductionThe safety and efficacy of insulin‐to‐liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin‐to‐liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA1c) and bodyweight in Japanese type 2 diabetes.Materials and MethodsJapanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β‐cell function‐related indices, such as increment of serum C‐peptide during glucagon stimulation test (GST‐ΔCPR). HbA1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks.ResultsOf 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12‐week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST‐ΔCPR. Receiver–operating characteristic analysis showed that GST‐ΔCPR of 1.34 ng/mL is a cut‐off point for insulin‐to‐liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co‐administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas.ConclusionsInsulin‐to‐liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST‐ΔCPR.

Glucagon-like peptide-1 receptor agonist therapeutics for total diabetes management: assessment of composite end-points

“…Ross also noted that the benefits of GLP-1 RA were more prominent in patients with shorter duration T2DM in one report on liraglutide. This is consistent with several reports demonstrating that the HbA1c-lowering effects of liraglutide depend on residual b-cell function such as may be found in patients with shorter duration of the disease [15][16][17] . Despite the possible amelioration of diabetic complications independently of glycemic control, there are important issues to be considered, including patient health-related quality of life (HRQOL) and cost-effectiveness; GLP-1 RAs involve injections, which often lower HRQOL, and there are considerably higher medical costs in comparison with oral anti-diabetic drugs.…”

Insulin treatment and longer diabetes duration both predict poorer glycaemic response to liraglutide treatment in type 2 diabetes: the Association of British Clinical Diabetologists Nationwide Liraglutide Audit

“…Consistent with this view, studies have shown that higher C-peptide secretion is predictive of a larger treatment response to liraglutide, 12,14 or a greater likelihood of success when switching patients to liraglutide from insulin. 15,16 The mean reduction in HbA1c with liraglutide was smaller for patients treated with insulin, relative to patients receiving other therapies, but nevertheless remained clinically significant. Recent clinical studies have shown that combinations of GLP-1 agonists and insulin are a rational treatment choice, as the inclusion of the GLP-1 agonist improves antihyperglycaemic efficacy while limiting the weight gain and hypoglycaemia associated with insulin.…”

Switching from Insulin to Liraglutide Improved Glycemic Control and the Quality of Life Scores in a Case of Type 2 Diabetes and Active Crohn's Disease

“…Therefore, the liraglutide treatment may have effectively compensated for a GLP-1 deficiency. Although the patient's GLP-1 concentration was not measured, his capacity for insulin secretion and insulin sensitivity robustly improved following the administration of liraglutide therapy; the patient exhibited a lower level of CPR secretion and a much lower CPI than the estimated predictive values for better glycemic control after the insulin-to-liraglutide switch (11,12), and the serum CPR and CPI values subsequently markedly improved. Although preservation of the beta cell function is usually required for effective treatment with liraglutide, there may well be certain highly responsive patients, similar to the present patient, with a short duration of diabetes and a low CPI.…”