Correlation between baseline characteristics and clinical outcomes in a large population of diabetes patients treated with liraglutide in a real-world setting in Italy.

PURPOSE: Treatment with liraglutide in randomized controlled trials is associated with significant reductions in glycated hemoglobin (HbA1c) and weight loss in type 2 diabetes patients. The aim of this retrospective observational study was to investigate correlations of glycemic control and weight outcomes with baseline characteristics of patients starting liraglutide in outpatient clinics in Italy. METHODS: Type 2 diabetes patients were followed from baseline to 4, 8, and 12 months. Changes in glycemic parameters, weight, blood pressure, and lipids were assessed. Subanalyses were performed according to baseline characteristics. Multivariate linear and logistic regressions were used to assess correlations between glycemic efficacy, weight reduction, and liraglutide discontinuation after 12 months and baseline characteristics. FINDINGS: Four hundred and eighty-one patients were included. Mean (SD) age at baseline was 57.3 (9.2) years, diabetes duration was 9.5 (6.8) years, weight was 106.7 (20.8) kg, body mass index (BMI; calculated as kg/m(2)) was 37.1 (6.6), HbA1c was 8.7% (1.3%), fasting plasma glucose was 168.5 (45.3) mg/dL; 38.2% were treated previously with insulin and 52.2% were treated with metformin alone. After 12 months, mean (SD) changes were HbA1c -1.2% (1.4%), fasting plasma glucose -28.3 (41.1) mg/dL, weight -3.5 (5.8) kg, BMI -1.3 (2.1), waist circumference -2.6 (6.7) cm (all, P < 0.001). Drop in weight and HbA1c did not differ between baseline BMI classes ≤30 or >30. Weight loss was unchanged among diabetes duration quartiles, and HbA1c reduction was significantly greater in patients with ≤4 years of diabetes duration (P = 0.01). Non-insulin-treated patients reached HbA1c ≤7% significantly more often than treated patients (44.2% vs 21.2%; odds ratio = 2.94; P < 0.001) and had significantly greater weight loss (-4.5 [8.2] kg vs -2.6 [5.4] kg; P = 0.03). Patients on metformin reached HbA1c target more frequently than others (43.1% vs 29.7%; odds ratio = 1.80; 95% CI, 1.05-3.07). Significant positive determinants for HbA1c reduction after 12 months were baseline HbA1c, age, and prior metformin monotherapy, and weight loss at 12 months was positively correlated with baseline weight, and negatively correlated with prior insulin treatment. Overall, 5.0% of patients interrupted liraglutide before the 12th month due to lack of glycemic control; they were less frequently treated with metformin only before liraglutide (29.2% vs 50.2%; P = 0.04). IMPLICATIONS: Treatment with liraglutide in a real-world setting is associated with low therapy failure, good glycemic response, weight loss, and improvement in systolic blood pressure and lipid profile. The HbA1c drop did not differ among baseline BMI classes, indicating that efficacy is maintained in patients with lower BMI. The probability of reaching HbA1c ≤7% was significantly higher in patients previously treated with metformin alone and without any previous insulin. This could reinforce the hypothesis that better results with liraglutide could be achieved in patients after early metformin failure.

Independent glucose and weight-reducing effects of Liraglutide in a real-world population of type 2 diabetic outpatients.

The GLP-1 receptor agonist Liraglutide is effective in reducing HbA1c in type 2 diabetic (T2D) patients. In addition, treatment with Liraglutide is associated with significant weight loss. In this study, we analyzed the inter-relationships between glycemic and weight effects of Liraglutide treatment in a population of type 2 diabetic outpatients. T2D patients initiating Liraglutide therapy since September 2010 to July 2012 at 3 outpatient clinics were enrolled and followed-up. We collected baseline information about anthropometric data, cardiovascular risk factors, diabetes duration, prevalence of complications and history of anti-diabetic medications. We collected HbA1c and body weight at baseline and every 4 months. A total of 166 patients were included, who were on average 56.6 ± 8.9 (mean ± SD) years old and had a baseline HbA1c of 8.7 ± 1.3 % and BMI 36.3 ± 6.4 kg/m(2). Mean follow-up was 9.4 ± 4.2 months (range 4-16). Patients lost on average 1.5 ± 1.3 % HbA1c and 4.0 ± 5.0 kg body weight. Most patients (73.5 %) improved HbA1c and loosed weight. Significant independent determinants of HbA1c drop were baseline HbA1c (r = 0.673; p < 0.001) and previous insulin therapy (r = -0.251; p < 0.001). The only independent determinant of weight loss was baseline BMI (r = 0.429; p < 0.001). Drop in HbA1c was unrelated to baseline BMI or weight loss. Weight loss was unrelated to baseline HbA1c or drop in HbA1c. Glycemic improvement and weight reduction obtained with Liraglutide treatment in T2D patients in a real-world setting are independent and possibly mediated by different mechanisms.