title: Use of Liraglutide in the Real World and Impact at 36 Months on Metabolic Control, Weight, Lipid Profile, Blood Pressure, Heart Rate, and Renal Function.
abstract: An observational retrospective study was conducted by 2 diabetes clinics in Italy to assess patterns of use and long-term effectiveness of liraglutide on established and emerging parameters.
  
  
  
  Data from 261 patients with type 2 diabetes who started treatment with liraglutide between 2010 and 2014 were collected. Hierarchical linear regression models were applied to assess trends over time of clinical parameters. Factors associated with higher likelihood of dropout were identified through multivariate logistic analysis.
  
  
  
  Liraglutide was initiated as a switch in 42.5% of patients and as an add-on in 49.8%; in 7.7% of the patients initiation of liraglutide was associated with a reduction in the number of pharmacologic agents. A statistically significant reduction after 36 months was found for the following parameters (mean change [95% CIs]): glycosylated hemoglobin (HbA1c; -1.01% [1.34% to -0.68%]), fasting blood glucose (-27.5 [-40.6 to -14.4] mg/dL), weight (-2.9 [-4.5 to -1.3] kg), body mass index (-1.13 [-1.76 to -0.50] kg/m2), waist circumference (-1.74 [-3.85 to -0.37] cm), and LDL-C (-24.7 [-36.67 to -12.8] mg/dL). Improvements in systolic (-3.5 mm Hg) and diastolic (-2.3 mm Hg) blood pressures were observed at 24 months. Albuminuria was reduced by -16.6 mg/L during 36 months, although statistical significance was not reached. Glomerular filtration rate and heart rate were unchanged. Reductions in HbA1cbetween -0.6% and -1.3% were obtained in specific subgroups. Treatment was effective also in patients with >20 years of diabetes duration, although the likelihood of dropout was 6% higher for each additional year of disease duration (RR = 1.06; 95% CI, 1.01-1.12). The likelihood of dropout was almost four times higher for subjects treated with insulin (RR = 3.82; 95% CI, 1.22-11.96) and more than twice for those treated with sulfonylureas (RR = 2.39; 95% CI, 1.16-4.94) compared with patients not treated with these agents.
  
  
  
  Liraglutide used in routine clinical conditions maintains its effectiveness on metabolic control and weight after 3 years. Improvements in terms of metabolic control were found when liraglutide was used as both switch and add-on treatment. In addition, improvements were sustained when liraglutide replaced sulfonylureas or insulin. Diabetes duration had no impact on drug efficacy. Long-term benefits relative to blood pressure and LDL-C were also found, which could not be entirely explained by antihypertensive/lipid-lowering treatment intensification. No major effect on renal parameters was documented. Diabetes duration and some concomitant treatments were associated with a higher likelihood of liraglutide discontinuation. These data can contribute to improve appropriateness and cost-effectiveness profile of liraglutide.
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rondinelli
authors.affiliation: Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, MultiMedica, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy; Diabetes Research Institute, Vita e Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gandolfi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Saponaro
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Bucciarelli
authors.affiliation: Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, MultiMedica, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Adda
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy; Diabetes Research Institute, Vita e Salute San Raffaele University, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Molinari
authors.affiliation: Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, MultiMedica, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Montefusco
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Specchia
authors.affiliation: CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Chiara Rossi
authors.affiliation: CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scardapane
authors.affiliation: Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, MultiMedica, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.affiliation: Diabetes Endocrine and Metabolic Disease Unit, IRCCS MultiMedica, Milan, Italy. Electronic address: stefano.genovese@multimedica.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Genovese
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D007558:Italy; D008055:Lipids / Q000097:blood; D000069450:Liraglutide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D000069450:Liraglutide
keywords: effectiveness; liraglutide; real world; type 2 diabetes