Objective: Attainment of appropriate A1C target is indispensable to reduce the risk of diabetes complications in type 2 diabetic (T2D) patients. The aim of this study is to evaluate the ability of GLP-1 receptor agonist, liraglutide (Lira), to achieve A1C <7.0% without increase of hypoglycemia risk.
Methods: A total of 194 patients (65.5±12.6 year-old) on Lira-based therapy (LBT) with T2D were included in the analysis. Effectiveness was compared before and after introduction of LBT. Glycaemic variability was evaluated by calculating hypoglycemia-sensitive ADRR score in patients who did self-blood glucose monitoring (SMBG). To avoid hypoglycemia, basal insulin was reduced when fasting blood glucose level reached <80mg/dL.
Results: 1) Before change to LBT, even on insulin based basal-bolus therapy (BBT) (n=21) only 23.8% of the patients achieved the target, and on pre-mixed insulin therapy (MIX) (n=34), 20.6%. 2) Change to LBT improved the average of A1C from 9.7% to 7.1%, and the target was achieved in 55.7% of all patients (n=108/194). 3) Further, all patients were analyzed after divided into 3 groups by the treatment: Lira mono-injection (n=71), Lira+basal insulin (n=106), Lira+BBT/MIX therapy (n=17) group. In Lira mono-injection group, A1C was markedly improved from 10.1% to 6.6%, although the duration of diabetes was shortest (6.7±8.0 years) among 3 groups. The proportion of patients who achieved the target was 69.0%, 50.0%, and 35.3%, respectively. 4) 61.8% of patients at age of 70s also achieved the target by LBT. 5) To optimize blood glucose excursion, SMBG was done in 59.3% of patients. In patients who achieved A1C <7.0%, 82.2% (37/45) showed ADRR scores less than 10. Moreover, in patients who achieved more stringent A1C <6.0%, 73.3% (11/15) of patients showed much lower ADRR scores less than 5, indicating marked reduction of hypoglycemia risk.
Conclusion: LBT makes it easier to achieve lower A1C target without risking hypoglycemia in all ages.
K. Kashima: None. H. Shimizu: None. M. Yamada: None.
