Background: Recent data from multiple international registries showed higher rates of overweight and obesity in adolescents with type 1 diabetes (T1DM) compared with their non-diabetic peers. Management of weight gain should be emphasized as obesity is a modifiable cardiovascular risk factor. Liraglutide is a glucagon like peptide‐1 receptor agonist approved for chronic weight management in adolescents with body weight above 60 kg and body mass index (BMI) corresponding to ≥30 kg/m2 for adults by international cut-offs.
Aim of the Study: To assess the effectiveness and safety of daily 3 mg subcutaneous (sc) Liraglutide amongst obese adolescents with T1DM.
Methods: The 26-week trial involved 28 T1DM obese adolescents (12 to 17 years) and a poor response to lifestyle therapy and exercise. They received liraglutide 3 mg sc daily with their usual insulin dose. Dose was titrated up on a weekly basis starting from 0.6 mg per day in weekly intervals of 0.6 mg, taking 5 weeks to achieve the maintenance dose of 3.0 mg daily. BMI, mean BG levels, HbA1c %, insulin dose, systolic and diastolic blood pressure were obtained at baseline and after the intervention.
Results: Of the 28 patients (females 85.7%), 20(71.4%) continued therapy for 26 weeks reached daily dose of Liraglutide 3.0 mg. Reduction in BMI of at least 5% was observed in 15 of 28 participants and a reduction in BMI of at least 10% was observed in 9 participants. The change from baseline in the BMI SD score at week 26, with an estimated treatment difference from baseline was (−0.28, [CI] −0.35 to −0.09; P=0.003). There was significant reduction of HbA1c from 8.3 to 7.7% (P=0.02). Mean fasting glucose concentrations significantly decreased from 142±12 to 115±8 mg/dl. Mean post‐prandial glucose increment decreased from 193±10 to 144±6 mg/dl. There was a concomitant fall in basal insulin from 28.5±6 to 21.3±9 units (P<0.001 for all) and total bolus insulin from 22.5±4 to 15.5±3 units (P=0.02) with moderate decrease in blood pressure but not significant. While adverse events were mainly gastrointestinal including nausea, dyspepsia, vomiting and constipation; no serious adverse events were reported.
Conclusion: Daily Liraglutide as an adjuvant therapy is effective in producing significant body weight reduction in obese adolescents with T1DM with tolerable minimal side effects. This was associated with improvement of glycemic control despite lower doses of insulin and without increase in hypoglycemic events.
15 Sep 2022 - 17 Sep 2022