Retrospective analysis of safety and efficacy of insulin-to-liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β-cell function.
OBJECTIVE
The safety and efficacy of insulin-to-liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin-to-liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA1c) and bodyweight in Japanese type 2 diabetes.


METHODS
Japanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β-cell function-related indices, such as increment of serum C-peptide during glucagon stimulation test (GST-ΔCPR). HbA1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks.


RESULTS
Of 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12-week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST-ΔCPR. Receiver-operating characteristic analysis showed that GST-ΔCPR of 1.34 ng/mL is a cut-off point for insulin-to-liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co-administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas.


CONCLUSIONS
Insulin-to-liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST-ΔCPR.
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Ryota
R
Usui
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan ; Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan.
Daisuke
D
Yabe
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Hitoshi
H
Kuwata
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Shuichi
S
Fujiwara
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Koin
K
Watanabe
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Takanori
T
Hyo
Division of Nephrology Kansai Electric Power Hospital Osaka Japan.
Akihiro
A
Yasuhara
Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan.
Masahiro
M
Iwasaki
Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan.
Naomi
N
Kitatani
Division of Nursing Kansai Electric Power Hospital Osaka Japan.
Kyoko
K
Kuwabara
Division of Nursing Kansai Electric Power Hospital Osaka Japan.
Kayo
K
Yokota
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Takeshi
T
Kurose
Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan.
Yutaka
Y
Seino
Glucagon stimulation test; Glucagon‐like peptide‐1 receptor agonist; β‐Cell function