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Liraglutide Shows Promise in Patient Satisfaction with Type 2 Diabetes
Injectable liraglutide, a long-acting glucagon-like peptide-1 (GLP-1), may lead to greater treatment satisfaction than oral sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor in patients with type 2 diabetes. February 15, 2011 - In patients with type 2 diabetes, injectable liraglutide may lead to greater treatment satisfaction than oral sitagliptin, potentially by facilitating greater improvement in glycemic control, weight loss and/ or perception of greater treatment efficacy, according to the findings of a randomized open-label trial. Melanie Davies, Professor of Diabetes Medicine, with the University of Leicester, in England, and colleagues reported their findings in the February 10, 2011, issue of Diabetic Medicine. According to the researchers, “Patient-reported outcomes and treatment satisfaction are important factors to consider when choosing a glucose lowering therapy for patients with Type 2 diabetes.” The patient-reported outcomes evaluation was a substudy of a 26-week randomized, open-label trial comparing the once-daily injectable liraglutide with once-daily oral sitagliptin, both added to metformin. The substudy was designed to evaluate treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline and 26 weeks. In the main trial, a total of 658 patients were randomized to receive once daily injectable liraglutide at a dose of 1.2 mg or 1.8 mg, or 100 mg of oral sitagliptin. All patents were also given 1500 mg of metformin daily. Liraglutide led to greater glycosylated hemoglobin (HbA1c) reduction than oral sitagliptin. The mean HbA1c reduction was 1.5%, 1.2% and 0.9% (7, 10 and 14 mmol⁄ mol) for liraglutide 1.8 mg, 1.2 mg and sitagliptin, respectively (P < 0.0001 for both liraglutide doses vs. sitagliptin). Patients receiving liraglutide also lost more weight (3 kg vs.1 kg; P < 0.0001). A total of 505 patients were included in the patient-reported outcomes substudy. Overall treatment satisfaction, calculated by adding satisfaction scores for ‘current treatment’, ‘convenience’, ‘flexibility’, ‘understanding’, ‘recommend’, and ‘continue’, improved in all groups at 26 weeks. A greater improvement was seen in patients given 1.8 mg of liraglutide compared with sitagliptin (P = 0.03). According to the researchers, the improved satisfaction with 1.8 mg of liraglutide “may reflect greater HbA1c reduction and weight loss.” Patients perceived themselves to be hyperglycemic significantly less frequently with liraglutide 1.8 mg (P < 0.0001) and 1.2 mg (P = 0.01). However, perceived frequency of hypoglycemia was similar across all groups. “These results challenge the perception that patients ‘prefer’ oral to injected glucose-lowering therapies,” the researchers note. However, according to the researchers, there is reluctance for clinicians to prescribe injectable therapies. “This reluctance to prescribe GLP-1 receptor agonists fail to take into account the fact that many commonly used anti-diabetic therapies are associated with weight gain and hypoglycemia, both of which negatively affect patient quality of life, and that weight gain itself may exacerbate other components of the metabolic syndrome,” they note. The study was funded by Watermeadow Medical (supported by Novo Nordisk A⁄ S, Bagsvaerd, Denmark). All authors either receive grant support from or are employees of Novo Nordisk. Diabetic Medicine. February 10, 2011 online.

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