GLP-1 Agonists in Type 1 Diabetes Mellitus

Jun 3, 2016The Annals of pharmacotherapy

Effects of GLP-1 Drugs in Type 1 Diabetes

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Abstract

A total of 9 clinical trials identified showed a maximum weight loss of 6.4 kg over 24 weeks with GLP-1 agonists in type 1 diabetes mellitus patients.

On average, hemoglobin A1C levels were lower than baseline, with a maximum decrease of 0.6%.
The reduction in A1C was not significant compared to a control group, showing a relative decrease of 0.1% to 0.2%.
Reported hypoglycemia was low and did not differ from insulin monotherapy.
Gastrointestinal side effects, particularly nausea, were frequently reported by patients.
Liraglutide showed the strongest evidence for effectiveness and is recommended for overweight or obese adults with uncontrolled type 1 diabetes.

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OBJECTIVE: To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM).

DATA SOURCES: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus

STUDY SELECTION AND DATA EXTRACTION: All English-language trials that examined glycemic end points using GLP-1 agonists in humans with T1DM were included.

DATA SYNTHESIS: A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea.

CONCLUSION: The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM.

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GLP-1 Agonists in Type 1 Diabetes Mellitus

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