NIV Congres

Introduction: Glucagon-like-peptide-1 (GLP-1) analogs are since 2009 approved in the Netherlands for the treatment of type 2 diabetes in patients with a BMI larger than 35kg/m² and inadequate glycaemic control with oral glucose-lowering medication. Literature shows a significant reduction in HbA_1c and body weight in comparison to placebo.

Aim: To determine the effect of GLP-1 analogs on glycaemic control and body weight in clinical practice.

Patients and Methods: From April 2010 until May 2012 we included all patients starting GLP-1 analogs (liraglutide/exenatide) at the Department of Internal Medicine in our hospital. At inclusion, all patients were diagnosed with type 2 diabetes. HbA_1c, body weight, medication (oral medication, insulin) and side effects were registered at baseline, after three and after six months.

Results: During the study period we included 238 patients. Mean age was 57.0 years, and 109 (46%) subjects were women. At baseline, mean HbA_1c was 67.8 mmol/mol, while mean BMI and mean body weight were 40.1 kg/m² and 117.7 kg respectively. Furthermore, 161 patients (68%) used any form of insulin therapy, 32% oral glucose-lowering medication only. 229 patients (96%) started liraglutide, while 9 (4%) started exenatide. HbA_1c decreased 6.3 mmol/mol (± 13.6 mmol/mol) and 6.0 mmol/mol (± 14.0 mmol/mol) after three and six months respectively (both p < 0.001 compared to baseline). Furthermore, a weight reduction of 7.9 kg (± 6.1 kg) and 11.3 kg (± 8.5 kg) was observed after three and six months respectively (both p < 0.001 compared to baseline).

At six months, 47 of 161 patients (29%) had stopped using any form of insulin therapy, while 51 (32%) using four or two times insulin therapy a day at baseline decreased towards once daily. Additionally, those who could not stop or change the baseline insulin regimen were able to significantly reduce the total daily dose of insulin.

During the study, 18 patients (8%) were discharged due to adequate glucose-regulation. 17 patients (7%) discontinued GLP-1 analogs due to lack of effect on glycaemic control, while 7 (3%) stopped due to intolerable side effects. No pancreatitis was observed during the study period.

Conclusion: GLP-1 analogs in the treatment of type 2 diabetes induce a significant reduction in HbA_1c and body weight. Additionally, we have demonstrated that patients already on insulin therapy benefit from GLP-1 analogs as well: despite significant reduction or discontinuation of insulin dose, HbA_1c levels and body weight decreased. We suggest that the present indication for the use of GLP-1 analogs in the Netherlands should be reconsidered.