Added to diet and exercise, once-daily treatment with subcutaneous liraglutide reduces the risk of developing diabetes among obese adults with prediabetes, concludes a trial in The Lancet.
The multicenter trial included 2254 obese adults (body mass index 30 kg/m2 or higher, or 27 kg/m2 or higher with comorbid conditions) meeting criteria for prediabetes. In a 2:1 ratio, patients were randomly assigned to receive once-daily liraglutide, 3.0 mg sc, or matching placebo. Both groups received a diet and exercise intervention. The main outcome of interest was time to onset of type 2 diabetes over 3 years’ follow-up.
Fifty percent of patients completed the study; withdrawal rates were 47% in the liraglutide group versus 55% in the placebo group. During double-blind follow-up, type 2 diabetes was diagnosed in 2% of patients in the liraglutide group versus 6% in the placebo group. Mean time to diabetes diagnosis was 99 versus 87 weeks, respectively.
After accounting for differences in diabetes frequency, time to diabetes onset in all randomized patients was 2.7 times longer with liraglutide versus placebo. The associated hazard ratio for type 2 diabetes was 0.21. After 3 years, mean weight loss was 6.1% of body weight in the liraglutide group versus 1.9% with placebo. Liraglutide was also associated with a higher rate of regression from prediabetes to normoglycemia: odds ratio 3.6, with a number needed to treat of 3. Adverse events, including serious events, were similar between groups.
In obese adults with prediabetes, daily treatment with liraglutide appears to reduce the risk of developing type 2 diabetes over 3 years’ follow-up, as an adjunct to lifestyle changes. Liraglutide is also associated with greater weight loss, improved glycemic control, and reduced cardiometabolic risk factors. The authors note that their study did not include follow-up data on the large proportion of patients who did not complete the study [le Roux CW, at el. 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; DOI. http://dx.doi.org/10.1016/S0140-6736(17)30069-7.