Mixed success for Victoza in type 1 diabetes trials

The results of two new studies reveal that Victoza (liraglutide) has mixed results when added to insulin in patients with type 1 diabetes.
Victoza is a glucagon-like peptide 1 (GLP-1) most commonly used to treat type 2 diabetes, but research is investigating its efficacy as a type 1 diabetes treatment.
In these new trials, called ADJUNCT ONE and ADJUNCT TWO, Victoza helped patients achieve better blood sugar levels and weight loss, but it also increased the risk of hypoglycemia and hyperglycemia with ketosis.
All patients in the trials were over 18 and had HbA1c levels above 7% (53 mmol/mol). They were treated with daily liraglutide alongside their normal insulin regimen.
In ADJUNCT ONE, the patients had their total daily insulin dose reduced at first, then increased if necessary. In ADJUNCT TWO, patients’ total daily insulin dose was individually capped.
In both studies, patients had improved HbA1c levels compared to placebo, and experienced reductions in total insulin dose and body weight. But both studies also showed liraglutide to be associated with higher rates of hypoglycemia and hyperglycemia with ketosis.
“These two large studies offer both reassurance as well continuing questions regarding the use of these agents on a larger scale in type 1 diabetes,” Mary Korytkowskin, MD, University of Pittsburgh Medical Centre, who wasn’t involved in the study, told Medscape Medical News.
“ADJUNCT ONE suggests that the higher incidence of hypo- and hyperglycemia with liraglutide limits the ability to recommend the clinical use of liraglutide in type 1 diabetes, while ADJUNCT TWO emphasizes the need for cautious insulin titration with close supervision of patients who receive these agents.
“Similar to what has been recommended for individualizing recommendations for pharmacologic therapy in type 2 diabetes, it is important to consider issues of safety, tolerability, and cost when prescribing this relatively new class of agents to selected patients with type 1 diabetes.”
The findings of these new trials were both published in the online journal Diabetes Care.