Liraglutide 3.0 mg for weight management in obese/overweight adults with Type 2 Diabetes: Results from the SCALE diabetes 56-week randomized, double-blind, placebo-controlled trial

Liraglutide: a review of its use in the management of obesity

Globally, obesity has reached epidemic proportions and poses an ever increasing burden from a societal and healthpayer perspective. Although lifestyle interventions are fundamental in its management, in the real world setting most obese or overweight adults require adjunctive pharmacotherapy to achieve clinically relevant reductions in bodyweight (i.e. a ≥5 % reduction). Subcutaneous liraglutide (Saxenda(®)) 3 mg once daily is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic bodyweight management in adults with an initial body mass index (BMI) of ≥30 kg/m(2) (obese) or a BMI of ≥27 kg/m(2) (overweight) and at least one bodyweight-related comorbidity [e.g. hypertension, dyslipidaemia, type 2 diabetes mellitus or obstructive sleep apnoea (OSA)]. In phase III trials (32 or 56 weeks' duration) in these populations, subcutaneous liraglutide was associated with clinically relevant reductions in fasting bodyweight and was generally well tolerated. Liraglutide was significantly more effective than placebo in terms of reductions in fasting bodyweight and waist circumference, and improvements in some biomarkers of cardiovascular risk. Improvements in bodyweight were maintained after up 2 years of liraglutide therapy. In nondiabetic adults with moderate to severe OSA, liraglutide improved apnoea-hypopnoea index scores at 32 weeks, which was largely driven by significant reductions in bodyweight. In the absence of head-to-head trials, the relative position of individual anti-obesity drugs remains to be fully determined. In the meantime, liraglutide is an emerging option, as an adjunct to a reduced-calorie diet and increased physical activity, for chronic bodyweight management in obese adults and overweight adults with at least one bodyweight-related comorbidity.

Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes

Type 2 diabetes mellitus (T2DM) is characterized by multiple pathophysiologic abnormalities. With time, multiple glucose-lowering medications are commonly required to reduce and maintain plasma glucose concentrations within the normal range. Type 2 diabetes mellitus individuals also are at a very high risk for microvascular complications and the incidence of heart attack and stroke is increased two- to three-fold compared with non-diabetic individuals. Therefore, when selecting medications to normalize glucose levels in T2DM patients, it is important that the agent not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality. In this review, we examine the effect of oral (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) and injectable (glucagon-like peptide-1 receptor agonists and insulin) glucose-lowering drugs on established CVRFs and long-term studies of cardiovascular outcomes. Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e., drug combinations designed to maximize HbA1c reduction while minimizing hypoglycaemia and excessive weight gain.