Evaluation of Glycemic Control and Cost Savings Associated With Liraglutide Dose Reduction at a Veterans Affairs Hospital

Abstract

G lucagon-like peptide 1 receptor agonists (GLP-1 RAs) are injectable incretin hormones approved for the treatment of type 2 diabetes mellitus (T2DM). They are highly efficacious agents with hemoglobin A 1c (HbA 1c) reduction potential of approximately 0.8 to 1.6% and mechanisms of action that result in an average weight loss of 1 to 3 kg. 1,2 Published in 2016, The LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial established cardiovascular benefits associated with liraglutide, making it a preferred GLP-1 RA. 3 In addition to HbA 1c reduction, weight loss, and cardiovascular benefits, liraglutide also has shown insulin-sparing effects when used in combination with insulin. A trial by Lane and colleagues revealed a 34% decrease in total daily insulin dose 6 months after the addition of liraglutide to insulin in patients with T2DM receiving > 100 units of insulin daily. 4 When used in combination with basal insulin analogues (glargine or detemir) similar findings also were shown. 5 The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) in Houston,