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New treatments and new choices for type 2 diabetes mellitus.

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  • Medicine


319 clinical J R Coll Physicians Edinb 2010; 40:319–20 doi:10.4997/JRCPE.2010.424 © 2010 Royal College of Physicians of Edinburgh SUMMARY This randomised controlled trial funded by the makers of liraglutide explores whether injectable or oral agents acting on the incretin system should be used in patients with type 2 diabetes mellitus in subjects inadequately controlled on metformin alone and naïve to other hypoglycaemic agents. This was a multinational study carried out in a number of European countries, Canada and the USA. Subjects in all three groups (described below) were normotensive but obese with a body mass index of around 33 kg/m2. They had moderate glycaemic control with mean glycated haemoglobin (HbA1c) levels of around 8.4%. The mean duration of diabetes was less than 6.5 years. Of 665 patients who entered the trial, 554 completed the 26-week study. There were three groups of subjects. One group received the dipeptidyl peptidase-4 (DPP4) inhibitor sitagliptin as a 100 mg tablet daily and the other two groups received the injectable glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide (a GLP-1 analogue). The latter two groups were made up of those who received 1.2 mg and 1.8 mg of liraglutide respectively. After 26 weeks, mean decreases in HbA1c from baseline were 0.9% for the sitagliptin group, 1.2% for the liraglutide 1.2 mg group and 1.5% for those on 1.8 mg of liraglutide. About 28% of participants had a baseline HbA1c greater than 9.0% and the decreases in HbA1c were more pronounced in this cohort, with 1.2% for those on sitagliptin, 1.7% for those on 1.2 mg liraglutide and 2.1% for those on 1.8 mg liraglutide. Therefore, significantly more patients achieved the stated HbA1c targets of <7.0% and ≤6.5% with liraglutide than with sitagliptin. At 26 weeks those on 1.8 mg liraglutide lost most weight (–3.38 kg) (95% confidence interval [CI], –3.91 to –2.84) compared with –2.86 kg (–3.39 to –2.2) for 1.2 mg liraglutide and –0.96

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