The Use of Liraglutide in Obese People With Type 1 Diabetes
Over 1 year, of 15 patients offered treatment, 7 declined and 8 proceeded (age 50 ± 6 years, 4 females). One patient with BMI 30kg/m was included due to rapid weight rise during insulin intensification such that the patient did not want to proceed without co-management of weight gain.
Summary results are presented in Table 1 and individual outcomes are shown in Figure 1.
(Enlarge Image)
Figure 1.
Percentage changes in weight (left panel) and total daily insulin dosage (right panel) over 3, 6 and 12 months compared to baseline in individual cases. Relevant individual baseline parameters are shown on the abscissa and are in ascending BMI order. Cases that withdrew at 6 months are denoted by an asterisk.
The baseline parameters were: BMI 40.4 ± 5.5 kg/m, (range 30–47.7 kg/m), weight 123.1 ± 23.9 kg (70.9–153.2 kg), HbA1c 8.5 ± 1.7% (7.1–12.5%), total daily insulin dose 131 ± 112 units/day (30–352 units/day), creatinine 76 ± 21 μmol/L (53–110), ACR 1.5 ± 2.4 mg/mmol (0.3–7.5), cholesterol 4.4 ± 0.8 mmol/L (3.2–5.5), C-peptide was negative (<94 pmol/l (analysed by the Mercodia C-peptide ELISA assay)) in 6 patients and low in 2 (281, 131 pmol/l), retinopathy status (none=1, background=2, pre proliferative and above=5), foot risk (low risk=5, intermediate risk=3) and only one patient had macrovascular complications.
On an intention to treat basis at 3, 6 and 12 months, weight loss was 6.8 ± 4.1 kg, 10.0 ± 5.6 kg and 9.0 ± 8.5 kg (range -21 to +6.8 kg) (p=0.026). Percentage weight loss at year end was 8 ± 6% (range +4 to -16%). Daily insulin dose fell by 52 ± 69 units, 50 ± 69 units and 43 ± 60 units (median 16, range -168 to +6 units) (p=0.107, ns). Insulin dosage in units/kg was 1.0 ± 0.9, 0.7 ± 0.4, 0.7 ± 0.4 and 0.7 ± 0.6 (p=0.136, ns). HbA1c changes were not significant (p=0.962, ns).
Two patients were unable to tolerate liraglutide and withdrew at 6 months. They are indicated in Figure 1. In one there was no response in any parameter (HbA1c, weight or insulin dose), also mandating withdrawal. In the other, weight and insulin dosage rose following cessation of GLP-1 therapy. Excluding these two cases (n=6), insulin dose reduction over 1 year was significant (p =0.044) at 12 months (-44 ± 66 units per day) but with no significant difference when assessed by units/kg (p=0.158, ns). Percentage weight loss at year end was 11 ± 3% (range -7 to -16%, p=0.003).
Alternatively, analysis to the 6 month time point (n=8) showed significant falls in weight (p=0.021) and a significant reduction in insulin either by total daily dose (p=0.045) or in daily units/kg (p=0.044) whilst HbA1c remained static.
There were no significant hypoglycaemic events nor any episodes of acute metabolic destabilisation.
Results
Over 1 year, of 15 patients offered treatment, 7 declined and 8 proceeded (age 50 ± 6 years, 4 females). One patient with BMI 30kg/m was included due to rapid weight rise during insulin intensification such that the patient did not want to proceed without co-management of weight gain.
Summary results are presented in Table 1 and individual outcomes are shown in Figure 1.
(Enlarge Image)
Figure 1.
Percentage changes in weight (left panel) and total daily insulin dosage (right panel) over 3, 6 and 12 months compared to baseline in individual cases. Relevant individual baseline parameters are shown on the abscissa and are in ascending BMI order. Cases that withdrew at 6 months are denoted by an asterisk.
The baseline parameters were: BMI 40.4 ± 5.5 kg/m, (range 30–47.7 kg/m), weight 123.1 ± 23.9 kg (70.9–153.2 kg), HbA1c 8.5 ± 1.7% (7.1–12.5%), total daily insulin dose 131 ± 112 units/day (30–352 units/day), creatinine 76 ± 21 μmol/L (53–110), ACR 1.5 ± 2.4 mg/mmol (0.3–7.5), cholesterol 4.4 ± 0.8 mmol/L (3.2–5.5), C-peptide was negative (<94 pmol/l (analysed by the Mercodia C-peptide ELISA assay)) in 6 patients and low in 2 (281, 131 pmol/l), retinopathy status (none=1, background=2, pre proliferative and above=5), foot risk (low risk=5, intermediate risk=3) and only one patient had macrovascular complications.
On an intention to treat basis at 3, 6 and 12 months, weight loss was 6.8 ± 4.1 kg, 10.0 ± 5.6 kg and 9.0 ± 8.5 kg (range -21 to +6.8 kg) (p=0.026). Percentage weight loss at year end was 8 ± 6% (range +4 to -16%). Daily insulin dose fell by 52 ± 69 units, 50 ± 69 units and 43 ± 60 units (median 16, range -168 to +6 units) (p=0.107, ns). Insulin dosage in units/kg was 1.0 ± 0.9, 0.7 ± 0.4, 0.7 ± 0.4 and 0.7 ± 0.6 (p=0.136, ns). HbA1c changes were not significant (p=0.962, ns).
Two patients were unable to tolerate liraglutide and withdrew at 6 months. They are indicated in Figure 1. In one there was no response in any parameter (HbA1c, weight or insulin dose), also mandating withdrawal. In the other, weight and insulin dosage rose following cessation of GLP-1 therapy. Excluding these two cases (n=6), insulin dose reduction over 1 year was significant (p =0.044) at 12 months (-44 ± 66 units per day) but with no significant difference when assessed by units/kg (p=0.158, ns). Percentage weight loss at year end was 11 ± 3% (range -7 to -16%, p=0.003).
Alternatively, analysis to the 6 month time point (n=8) showed significant falls in weight (p=0.021) and a significant reduction in insulin either by total daily dose (p=0.045) or in daily units/kg (p=0.044) whilst HbA1c remained static.
There were no significant hypoglycaemic events nor any episodes of acute metabolic destabilisation.