Clinical Edge

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Reducing T2D Risk in Obese Persons with Prediabetes

Lancet; 2017 Apr 8; le Roux, Astrup, et al

Publish date:

Reduced risk of diabetes in individuals with obesity and prediabetes may be provided with liraglutide, according to a study that included patients from 27 countries. In the randomized, double-blind, placebo-controlled trial, adults with prediabetes and a body mass index (BMI) of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomized 2:1 to once-daily subcutaneous liraglutide 3.0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome. The study ran between June 1, 2011, and March 2, 2015. Researchers found:

  • 2,254 patients were randomly assigned to receive either liraglutide (n=1,505) or placebo (n=749); 1,128 (50%) completed the study up to week 160.
  • By week 160, 26 (2%) of 1,472 individuals in the liraglutide group vs 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment.
  • The time to onset of diabetes over 160 weeks among all randomized individuals was 2.7 times longer with liraglutide than with placebo.
  • Liraglutide also induced greater weight loss vs placebo (–6.1 % vs −1.9%).

Citation:

le Roux CW, Astrup A, Fujioka K, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: A randomised, double-blind trial. Lancet. 2017;389:1399-1409. doi:10.1016/S0140-6736(17)30069-7.

Commentary:

Liraglutide (Saxenda) at the 3 mg daily dose is FDA approved for treatment of obesity. This study answers an important question, which is whether the weight loss that occurs with the use of liraglutide also decreases progression to diabetes in patients who have prediabetes and who are overweight with 2 comorbidities or obese. The approximately 65% decrease in progression from prediabetes to diabetes in this group is a meaningful one. Other pharmacologic agents that have demonstrated efficacy in slowing progression from prediabetes to diabetes are metformin, alpha-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones. Currently, the American Diabetes Association’s Standards of Care 2017 emphasize lifestyle modification to decrease progression from prediabetes to diabetes, and if pharmacologic therapy is to be used, then metformin is recommended as having the strongest evidence base and long-term safety record.1 —Neil Skolnik, MD

  1. American Diabetes Association’s Standards of Care 2017. Diabetes Care. 2017;40(Suppl. 1):S4–S5. doi:10.2337/dc17-S003.

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