Correlation Between Baseline Characteristics and Clinical Outcomes in a Large Population of Diabetes Patients Treated with Liraglutide in a Real-World Setting in Italy
2015
Abstract Purpose Treatment with liraglutide in randomized controlled trials is associated with significant reductions in glycated hemoglobin (HbA 1c ) and weight loss in type 2 diabetes patients. The aim of this retrospective observational study was to investigate correlations of glycemic control and weight outcomes with baseline characteristics of patients starting liraglutide in outpatient clinics in Italy. Methods Type 2 diabetes patients were followed from baseline to 4, 8, and 12 months. Changes in glycemic parameters, weight, blood pressure, and lipids were assessed. Subanalyses were performed according to baseline characteristics. Multivariate linear and logistic regressions were used to assess correlations between glycemic efficacy, weight reduction, and liraglutide discontinuation after 12 months and baseline characteristics. Findings Four hundred and eighty-one patients were included. Mean (SD) age at baseline was 57.3 (9.2) years, diabetes duration was 9.5 (6.8) years, weight was 106.7 (20.8) kg, body mass index (BMI; calculated as kg/m 2 ) was 37.1 (6.6), HbA 1c was 8.7% (1.3%), fasting plasma glucose was 168.5 (45.3) mg/dL; 38.2% were treated previously with insulin and 52.2% were treated with metformin alone. After 12 months, mean (SD) changes were HbA 1c −1.2% (1.4%), fasting plasma glucose −28.3 (41.1) mg/dL, weight −3.5 (5.8) kg, BMI −1.3 (2.1), waist circumference −2.6 (6.7) cm (all, P 1c did not differ between baseline BMI classes ≤30 or >30. Weight loss was unchanged among diabetes duration quartiles, and HbA 1c reduction was significantly greater in patients with ≤4 years of diabetes duration ( P = 0.01). Non−insulin-treated patients reached HbA 1c ≤7% significantly more often than treated patients (44.2% vs 21.2%; odds ratio = 2.94; P P = 0.03). Patients on metformin reached HbA 1c target more frequently than others (43.1% vs 29.7%; odds ratio = 1.80; 95% CI, 1.05−3.07). Significant positive determinants for HbA 1c reduction after 12 months were baseline HbA 1c , age, and prior metformin monotherapy, and weight loss at 12 months was positively correlated with baseline weight, and negatively correlated with prior insulin treatment. Overall, 5.0% of patients interrupted liraglutide before the 12th month due to lack of glycemic control; they were less frequently treated with metformin only before liraglutide (29.2% vs 50.2%; P = 0.04). Implications Treatment with liraglutide in a real-world setting is associated with low therapy failure, good glycemic response, weight loss, and improvement in systolic blood pressure and lipid profile. The HbA 1c drop did not differ among baseline BMI classes, indicating that efficacy is maintained in patients with lower BMI. The probability of reaching HbA1c ≤7% was significantly higher in patients previously treated with metformin alone and without any previous insulin. This could reinforce the hypothesis that better results with liraglutide could be achieved in patients after early metformin failure.
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