Adjuvant Liraglutide and Insulin Versus Insulin Monotherapy in the Closed-Loop System in Type 1 Diabetes
| Autor: | Neesha Ramchandani, Martin Cantwell, Rubina A. Heptulla, Jeniece Ilkowitz, Ranjitha Katikaneni |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Biomedical Engineering 030209 endocrinology & metabolism Bioengineering Glucagon 03 medical and health sciences Insulin Infusion Systems 0302 clinical medicine Internal medicine Internal Medicine medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Glycemic Type 1 diabetes Cross-Over Studies Liraglutide business.industry Incidence Original Articles Middle Aged medicine.disease Crossover study Glucagon-like peptide-1 Diabetes Mellitus Type 1 Postprandial Endocrinology ROC Curve Area Under Curve Hyperglycemia Female business medicine.drug |
| Zdroj: | Journal of Diabetes Science and Technology. 10:1108-1114 |
| ISSN: | 1932-2968 |
| Popis: | Background: The closed-loop (CL) system delivers insulin in a glucose-responsive manner and optimal postprandial glycemic control is difficult to achieve with the algorithm and insulin available. We hypothesized that adjunctive therapy with liraglutide, a once-daily glucagon-like peptide-1 agonist, would be more effective in normalizing postprandial hyperglycemia versus insulin monotherapy in the CL system, in patients with type 1 diabetes. Methods: This was a randomized, controlled, open-label, crossover design trial comparing insulin monotherapy versus adjuvant subcutaneous liraglutide 1.2 mg and insulin, using the CL system in 15 patients. Blood glucose (BG), insulin, and glucagon concentrations were analyzed. Results: The liraglutide arm was associated with overall decreased mean BG levels ( P = .0002). The average BG levels from 8:00 pm (day 1) to 9:00 pm (day 2) were lower in the liraglutide arm (144.6 ± 36.31 vs 159.7 ± 50.88 mg/dl respectively; P = .0002). Two-hour postbreakfast and lunch BG profiles were better in the liraglutide arm ( P < .05) and the insulin and glucagon assay values were lower ( P < .0001). Postprandially, the area under the curve (AUC) for 2-hour postbreakfast and lunch BG levels were significant ( P = .01, P = .03) and the AUC for glucagon, postbreakfast ( P < .0001) and lunch ( P < .05), was also significant. The incidence of hypoglycemia did not differ between arms ( P = .83, Fisher’s exact test). Overall, adjunct liraglutide therapy plus CL was well tolerated even with expected side effects. Conclusion: This is a proof-of-concept study showing liraglutide can be a potential adjunctive therapy in addition to CL with insulin to reduce postprandial hyperglycemia in type 1 diabetes. |
| Databáze: | OpenAIRE |
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