[acb-diabetics] new study shows better control for type 1

[Patricia LaFrance-Wolf]

22-Jun-2011

June 2011 - Results of a small, observational study conducted at the
University at Buffalo suggest that liraglutide, an injectable medication
used to treat type 2 diabetes, also helps type 1 diabetics on insulin
achieve optimal control of their blood glucose levels.

If the findings are confirmed in a larger, prospective, randomized study now
being planned by the UB researchers, they could mean the first significant,
new treatment for type 1 diabetes since insulin was discovered and made
available in the 1920s.

The research has been published online here
<http://www.eje-online.org/content/early/2011/06/06/EJE-11-0330.abstract>
in the European Journal of Endocrinology. It also was recently presented at
the annual meeting of the Endocrine Society in Boston, where it received
recognition as one of the most outstanding abstracts presented and the best
in the field of diabetes.

"Since the development of injectable insulin, there has been nothing
definitive in terms of a significant advance in type 1 diabetes treatments,"
says Paresh Dandona, MD, PhD, UB distinguished professor of medicine in the
School of Medicine and Biomedical Sciences and senior author on the study.
"That is the tragedy of the type 1 diabetic.

"This study shows that liraglutide can provide even well-controlled type 1
diabetics with additional benefits that help them achieve even better blood
glucose levels," says Dandona.

The patients on liraglutide, which is marketed as Victoza, also saw a
reduction in appetite and food intake and the paper reports that body weight
significantly fell in patients who took the drug for 24 weeks.

The unfunded study was a retrospective analysis of data. It was conducted at
Kaleida Health's Diabetes-Endocrinology Center of Western New York, which
Dandona directs.

At the start of the study, all 14 patients had hemoglobin A1C levels of
under 7, which is considered optimal. They were characterized in the paper
as "well-controlledÂ
meticulous and disciplined" in terms of their ability
to control their blood glucose levels with insulin.

Nevertheless, Dandona notes, even well-controlled type 1 diabetics still
experience "glycemic excursions," fairly wide swings in their blood glucose
numbers ranging from the hyperglycemic, from 150 milligrams per deciliter to
250 mg/dl or higher to the hypoglycemic, under 70 mg/dl.

"The addition of liraglutide to insulin therapy in these well-controlled
type 1 diabetics resulted in a significant and rapid reduction in glycemic
excursions and, as a consequence, a rapid reduction in the amount of insulin
they needed to take," Dandona explains.

Several figures in this presentation by Dandona clearly demonstrate this
effect.

These improvements occurred rapidly, within 1-2 days of beginning treatment
with liraglutide and they reversed just as rapidly when treatment was
discontinued, signifying that it was the drug that was responsible for these
beneficial effects.

The mechanism behind these improvements is not well-understood but Dandona
and his co-authors suggest that liraglutide may be suppressing the post-meal
increase in glucagon, the hormone that raises glucose levels, in type 1
diabetics.

Dandona and his colleagues are now planning a much larger, multicenter study
of liraglutide in type 1 diabetics.

"We will be investigating in detail the hypothesis that it is liraglutide's
ability to suppress glucagon that significantly reduces the wide swings in
blood glucose levels that type 1 diabetics -- even those with very good
glucose control -- live with everyday," says Dandona.

The retrospective study involved 14 adult type 1 diabetics who took
liraglutide for periods ranging from one week to 24 weeks.

Co-authors with Dandona are: Ajay Varanesi, endocrinology fellow; Natalie
Bellini, honorary research fellow; Deepti Rawal, MD, UB medical resident;
Mehul Vora, clinical assistant instructor; Sandeep Dhindsa, assistant
professor of medicine; Antoine Makdissi, assistant professor of medicine;
and Ajay Chaudhuri, MD, associate professor of medicine.

Source: University at Buffalo, The State University of New York

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