The use of liraglutide, a GLP-1 agonist, in obese people with type 1 diabetes

Abstract

Aims: Optimisation of glycaemic control in type 1 diabetes often results in unwanted weight gain. glucagon-like peptide-1 (GLP-1) agonist use is associated with weight reduction in type 2 diabetes but its use in type 1 diabetes is little studied. Methods: We developed a protocol for GLP-1 use in people with type 1 diabetes and obesity in which liraglutide was initiated and up-titrated whilst insulin doses were simultaneously titrated according to glycaemic parameters. Results: Of 15 patients offered treatment, 8 proceeded. Baseline parameters were (n=8, mean + SD): (age 50 ± 6 years, BMI 40.4 ± 5.5 kg/m 2 , weight 123.0 ± 23.9 kg, HbA1c 8.5 ± 1.7%, total daily insulin dose 131 ± 112 units/day. By intention to treat analysis (n=8, 12 months), at 3, 6 and 12 months compared to baseline, weight loss was 6.8 ± 4.1 kg, 10.0 ± 5.6 kg and 8.9 ± 8.4 kg (p=0.026). The reductions in insulin dosage were significant over 6 months (n=8, p=0.045) or when analysing only those who completed 12 months of liraglutide therapy (n=6, p=0.044). Conclusions: GLP-1 agonist use in patients with type 1 diabetes may be advantageous where weight reduction becomes both a constraint and a therapeutic objective. Br J Diabetes Vasc Dis 2014;14:98-101

Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations on the use of sodium–glucose cotransporter inhibitors with insulin for treatment of type 1 diabetes (Updated October 2020)

“…GLP‐1 analogues and receptor agonists may be helpful in subgroups of people with type 1 diabetes but the reductions in HbA 1c are modest [MD −3 mmol/mol (−0.24%) with liraglutide 1.8 mg] although weight reductions were significant (4.87 kg with liraglutide 1.8 mg), insulin dose reduced, hypoglycaemia reduced but not significantly (OR 0.80) and GI adverse events increased significantly (OR nausea 4.70, vomiting 2.50) 25,26 . DPP4 inhibitors added to insulin did result in a small but insignificant reduction in HbA 1c [1 mmol/mol (0.07%)] and no consistent effect on glucose variability in people with type 1 diabetes 27 .…”

Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations on the use of sodium-glucose co-transporter inhibitors with insulin for treatment of type 1 diabetes (updated October 2020)

“…24 GLP-1 analogues and receptor agonists may be helpful in subgroups of people with type 1 diabetes, but the reductions in HbA1c are modest (MD −3 mmol/mol (−0.24%) with liraglutide 1.8 mg) although weight reductions were significant (4.87 kg with liraglutide 1.8 mg), insulin dose reduced, hypoglycaemia reduced but not significantly (OR 0.80) and gastrointestinal adverse events increased significantly (OR nausea 4.70, vomiting 2.50). 25,26 Dipeptidyl peptidase-4 (DPP4) inhibitors added to insulin did result in a small but insignificant reduction in HbA1c (1 mmol/mol (0.07%)) and no consistent effect on glucose variability in people with type 1 diabetes. 27 By contrast, SGLT inhibitors are oral glucose-lowering drugs with potential as long as they are used appropriately.…”

Association of British Clinical Diabetologists (ABCD) position statement on the use of sodium-glucose cotransporter-2 inhibitors in type 1 diabetes (updated 2019)

“…[18][19][20] Glucagon-like peptide-1 (GLP-1) analogues and receptor agonists may be helpful in subgroups of people with type 1 diabetes but the data are limited. 21 Dipeptidyl peptidase-4 (DPP4) inhibitors have not shown consistent positive effects on glycaemic control or glucose variability in people with type 1 diabetes. 22 By contrast, SGLT-2 inhibitors are oral glucose lowering drugs with potential in this group of people with diabetes and are being increasingly used off-label.…”