Objective: Despite advanced new medications, the rate of achieving HbA1c target <7% is only around 50%. The aim of study is to evaluate the ability of GLP-1 receptor agonist to achieve this target compared to insulin therapy.
Methods: A total of 154 type 2 diabetic (T2DM) patients on liraglutide (LIRA) based therapy and 124 T2DM patients on insulin based therapy were randomly recruited. The rate of patients achieving the target and background characteristics were compared.
Results: 1) The rate of achieving HbA1c<7% was 41.6% on insulin vs. 61.0% on LIRA. HbA1c<6% was only 7.3% on insulin, but 19.4% on LIRA, although self-blood glucose monitoring (SMBG) was equally done (52.4% vs. 51.9%). 2) Divided into 3 regimes: LIRA mono-injection, LIRA+basal insulin, LIRA+basal bolus (BBT)/pre-mixed insulin therapy, achieving HbA1c<7% rate much varied: 76.3%, 56.9%, and 35.0%. Achieving HbA1c<6% rate was 21.8%, 21.5%, and 5.0% without hypoglycemia. In mono-injection group, the rate of SMBG (30.9%) was lower than other 2 groups (58.2%, 80.0%), and less cost. Moreover, prominent effect was attained in this group, HbA1c improved from 9.9±2.9 to 6.6±0.9% (p<0.01), and BMI improved from 24.5±5.9 to 23.6±5.3kg/m2 (p<0.05) by adding LIRA. In background characteristics, the duration of diabetes was shortest (6.6±6.3 year) in this group, compared with LIRA+basal (11.2±8.8 year) or LIRA+BBT/pre-mixed (15.6±10.6 year) group. But ischemic heart disease (12.7%), chronic kidney disease (30.9%), and obesity (30.9%) complication rates were still high. 4) In one of the patients with a year duration of diabetes, after changing the regime from BBT into LIRA+basal insulin, marked improvement in HbA1c from 8.2% to 5.6% with narrowing blood glucose range 126∼349mg/dL into 79∼145mg/dL was found, and durability for 3 years was confirmed.
Conclusion: Since T2DM is a complex metabolic disorder, LIRA should be started early years to get its maximum benefit of LIRA.
K. Kashima: None. H. Shimizu: Speaker's Bureau; Self; Eli Lilly and Company, MSD K.K., Daiichi Sankyo Company, Limited, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc.. M. Yamada: None.