Upon diagnosis with type 2 diabetes, individuals are often advised to make lifestyle changes, and begin a first-line medication, such as metformin. This course of action does not always work for everyone, however, and often a second-line treatment can be utilized. In 2014, Liraglutide was approved by the FDA as a second-line therapy for treating type 2 diabetes, adding to a short list of these medications. What sets liraglutide apart, however, is its benefits beyond treating diabetes alone.
“I’ve been excited about liraglutide for a long time because I think it’s unique. This is the first diabetes drug that has shown across-the-board benefits for cardiovascular diseases, and this suggests it plays a role in treating atherosclerosis, which is what leads to heart attacks and strokes.”
– Buse, who is also an author of the worldwide LEADER clinical trial studying liraglutide
Cardiovascular complications and kidney disease can often develop in those living with type 2 diabetes, with cardiovascular disease being the number one cause of fatality. In an expansive clinical trial, liraglutide demonstrated its ability to reduce the risk of both of these complications, making it the first medication with the primary goal of lowering blood sugar to provide additional wide-ranging benefits to those with T2D.
The clinical trial, published in June in the New England Journal of Medicine, involved hundreds of institutions in 32 countries, making it truly a worldwide project. The trial, entitled, “Liraglutide Effect and Action in Diabetes Evaluation of Cardiovascular Outcome Results”, or LEADER, began in 2010 and involved a randomized double-blind study of 9,340 adults over the age of 50 living with T2D. These individuals were also determined to be at high risk of cardiovascular disease.
The group was split into two demographic and clinically similar groups, in which half received liraglutide and the other a placebo. All of the individuals received liraglutide or the placebo in addition to their standard care, which, for many, included blood pressure or cholesterol medications. The results of the trial indicated that individuals who received liraglutide, in relation to those who didn’t showed:
22% lower risk of cardiovascular mortality
22% lower risk of new evidence of advanced kidney disease
13% lower risk of having a heart attack or stroke, or dying from cardiovascular disease
15% lower risk of all-cause mortality
Liraglutide acts as a GLP-1 agonist, meaning it works in the pancreas to decrease the production of glucagon (an anti-insulin hormone), and increase insulin secretion, as well as targets the brain where it reduces appetite and increases the feeling of fullness (satiety). Other second-line therapies have shown promise of reducing cardiovascular complications, such as SGLT-2 inhibitor, empagliflozin, but none have shown results as strong and clear as liraglutide. Some scientists believe the next step in in T2D research is to try to combine liraglutide with drugs that work as different types of inhibitors to further decrease the risk of cardiovascular complications.1-2
Marso SP et al. “Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes.” Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1603827 [Accessed 29 June 2016.]
UNC Health Care. “Diabetes Drug Lowers Risk of Cardiovascular Complications, Kidney Disease.” http://news.unchealthcare.org/news/2016/june/diabetes-drug-lowers-risk-of-cardiovascular-complications-kidney-disease [Accessed 29 June 2016.]