Weight loss greater with higher-dose liraglutide in diabetes

The take-home message is that this study shows liraglutide 3 mg is effective in terms of weight loss in obese and overweight adults with type 2 diabetes. There also was a beneficial effect on HbA_1c. It appeared that the higher dose of 3 mg had even better effects than the currently approved 1.8-mg dose on weight and on HbA_1c in this particular patient group. The side effect profile appeared to be similar to the 1.8-mg dose. The 3-mg dose seemed to be safe.

If the 3-mg dose was indicated and licensed, I think it would be entirely reasonable to use it, particularly in the morbidly obese population with type 2 diabetes, because you get a better effect in terms of HbA_1c reduction and weight loss.

Dr. Thomas Barber

Whenever you’re increasing a dose with any medication, there’s always a concern about promotion of side effects. In this study, it appeared that the higher dose was tolerated really well. There didn’t seem to be a big difference between the 3-mg and 1.8-mg dose in that regard. That’s kind of reassuring for physicians when considering a higher dose.

There are other treatment options, including the SGLT2 (sodium glucose co-transporter 2) inhibitors, which are orally administered and also can promote weight loss by a completely different mechanism. SGLT2 inhibitors are indicated for patients with type 2 diabetes who have poor control. A plus is that they can be orally administered.

If you look at diabetes therapies in general, things like sulfonylureas, thiazolidinediones, and insulin promote weight gain. That’s a big problem because that makes insulin resistance worse. Having a diabetes therapy that can also promote weight loss is hugely beneficial. As a diabetologist, I put huge value on a drug that promotes weight loss in this context. I think we now have two major groups – the GLP1 (glucagon-like peptide 1) agents, of which liraglutide is one, and the SGLT2 inhibitors – both of which can achieve that. I think it’s a very useful addition to our armamentarium and management.

Thomas Barber, M.D., is associate professor and honorary consultant endocrinologist at the University of Warwick, England. He gave these comments in an interview at the meeting. Dr. Barber reported having no financial disclosures.