Bruinstroop Eveline, Meyer Laura, Brouwer Catherine B, van Rooijen Diana E, van Dam P Sytze
Department of Internal Medicine, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
Department of Research and Epidemiology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
Diabetes Ther. 2018 Jun;9(3):1369-1375. doi: 10.1007/s13300-018-0438-9. Epub 2018 May 19.
Insulin and the GLP-1 receptor agonist liraglutide are both effective in reaching glycemic targets. The efficacy of an insulin-to-liraglutide switch in an obese population with concurrent use of sulfonylurea and metformin is unknown. We assessed the efficacy and determinants of success of an insulin-to-liraglutide switch in these patients.
In a retrospective study we analyzed all patients that underwent an insulin-to-liraglutide switch during routine medical care (January 2009-February 2015). It was assessed if patients still continued liraglutide 12 months after the switch or discontinued because of poor glycemic control or side effects. Baseline characteristics were compared between the groups to establish determinants of success.
A total of 104 patients made an insulin-to-liraglutide switch (43% male; mean age 57.2 ± 9.9 years; mean BMI 39.8 ± 5.4 kg/m). Sixty patients still continued liraglutide after 12 months (58%) whereas 37 patients discontinued treatment because of poor glycemic control within 12 months (36%) and seven patients discontinued liraglutide because of intolerable side effects (7%). Insulin dose and insulin frequency at baseline were significantly lower in patients that continued liraglutide. Patients reaching HbA1c ≤ 7% (53 mmol/mol) showed lower baseline HbA1c levels, shorter duration of diabetes, and shorter duration of insulin therapy.
The majority of patients continued liraglutide after a switch from insulin therapy with on average no change in glycemic control and decrease of body weight. HbA1c levels at baseline, duration of insulin therapy, and duration of diabetes were predictive of reaching glycemic control on liraglutide alone. In current practice this also indicates which patients on insulin can reduce their insulin dose after adding a GLP-1 receptor agonist. Plain language summary available for this article.
胰岛素和胰高血糖素样肽-1（GLP-1）受体激动剂利拉鲁肽在实现血糖目标方面均有效。在同时使用磺脲类药物和二甲双胍的肥胖人群中，从胰岛素转换为利拉鲁肽的疗效尚不清楚。我们评估了这些患者从胰岛素转换为利拉鲁肽的疗效及成功的决定因素。
在一项回顾性研究中，我们分析了在常规医疗护理期间（2009年1月至2015年2月）所有从胰岛素转换为利拉鲁肽的患者。评估患者在转换后12个月是否仍继续使用利拉鲁肽，还是因血糖控制不佳或副作用而停药。比较各组的基线特征以确定成功的决定因素。
共有104例患者从胰岛素转换为利拉鲁肽（男性占43%；平均年龄57.2±9.9岁；平均体重指数39.8±5.4kg/m²）。60例患者在12个月后仍继续使用利拉鲁肽（58%），而37例患者在12个月内因血糖控制不佳而停药（36%），7例患者因无法耐受的副作用而停用利拉鲁肽（7%）。继续使用利拉鲁肽的患者基线时的胰岛素剂量和胰岛素使用频率显著更低。糖化血红蛋白（HbA1c）≤7%（53mmol/mol）的患者基线HbA1c水平更低、糖尿病病程更短、胰岛素治疗时间更短。
大多数患者从胰岛素治疗转换为利拉鲁肽后继续使用利拉鲁肽，平均血糖控制无变化且体重减轻。基线HbA1c水平、胰岛素治疗时间和糖尿病病程可预测仅使用利拉鲁肽时能否实现血糖控制。在当前实践中，这也表明哪些胰岛素治疗患者在加用GLP-1受体激动剂后可以减少胰岛素剂量。本文提供通俗易懂的总结。
