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Long-term Victoza treatment in early type 2 diabetes could increase hyperglucagonemia

Liraglutide (Victoza) results in higher postprandial glucagon levels (hyperglucagonemia) during long-term treatment, according to new research.
The research was tested in adult patients with early type 2 diabetes and compared use of liraglutide to a placebo. The research does not present any concern for patients but may help researchers and diabetologists to better understand how the drug works.
Liraglutide is a type 2 diabetes drug – marketed as Victoza – that helps reduce blood glucose levels and aid weight loss in patients.
This study, conducted by Mount Sinai Hospital, Canada, involved 51 adults who had type 2 diabetes for an average duration of 2.6 years. The participants were either assigned to daily liraglutide injection or placebo injection. Over a three-week period, the dose rose from 0.6 mg to 1.8 mg – it was then maintained at 1.8 mg for 48 weeks.
Prior to the study, a two-hour 75 g oral glucose tolerance test was conducted, and again at 12, 24, 36 and 48 weeks. Metformin therapy was instigated if participants had an HbA1c of eight per cent or higher after a test.
The researchers discovered post-meal improvements in insulin secretion and C-peptide response, indicating that less insulin needed to be produced by the patients. Reduced blood glucose levels were also observed after food was eaten.
“Intriguingly, however, liraglutide also induced an unanticipated increase in post-challenge glucagonemia that first emerged at 12 weeks and persisted over the course of 48 weeks of treatment,” said the researchers.
The results also showed, however, that glucagon levels were lower during fasting periods for people taking liraglutide compared to placebo.
The researchers note that the glucose-lowering effects of liraglutide may not be directly attributed to post-meal glucagon suppressio, as has previously been understood. As glucagon works by helping the body to shed body fat, it may not be so surprising that liraglutide, which is known to benefit weight loss, should be linked with higher glucagon levels.
They concluded that “chronic treatment with liraglutide is associated with increased post-challenge hyperglucagonemia in patients with early T2DM,” and that further studies are needed to confirm why longer duration of liraglutide therapy is linked with higher glucagon levels and whether this may be a benefit or not.
The results of this study were published in the Journal of Endocrinology and Metabolism.

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