Exp Clin Endocrinol Diabetes 2020; 128(03): 170-181
DOI: 10.1055/a-0636-3961
Article
© Georg Thieme Verlag KG Stuttgart · New York

Quality of Life, Glycemic Control, Safety and Tolerability Associated with Liraglutide or Insulin Initiation in Patients with Type 2 Diabetes in Germany: Results from the Prospective, Non-interventional LIBERTY Study

Rainer Lundershausen
1   Diabetes Centre Erfurt/Bad Berka, Erfurt, Germany
,
Sabrina Müller
2   Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Wismar, Germany
,
Mahmoud Hashim
3   Ingress Health, AC Rotterdam, The Netherlands
,
Joachim Kienhöfer
4   Novo Nordisk Pharma GmbH, Mainz, Germany
,
Stefan Kipper
4   Novo Nordisk Pharma GmbH, Mainz, Germany
,
Thomas Wilke
2   Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Wismar, Germany
› Author Affiliations
Funding This study was supported by Novo Nordisk Pharma GmbH, which initiated the study and was involved in the study design, collected case report forms completed by treating physicians, and was responsible for data management. The statistical analyses were performed under the supervision of Novo Nordisk Pharma GmbH. Novo Nordisk reviewed this article for medical accuracy. Two of the authors are employees of Novo Nordisk Pharma GmbH and were involved in interpretation of the data, preparation of the article, and decision to submit the article for publication.
Further Information

Publication History

received 12 December 2017
revised 09 May 2018

accepted 29 May 2018

Publication Date:
29 August 2018 (online)

Abstract

Purpose To assess quality of life, glycemic control, and safety/tolerability associated with liraglutide versus insulin initiation in patients with type 2 diabetes in Germany.

Methods Liraglutide/insulin-naïve adults with type 2 diabetes and inadequate glycemic control despite using oral antidiabetic medication were assigned to liraglutide (≤1.8 mg daily; n=878) or any insulin (n=382) according to the treating physician’s decision and followed for 52 weeks. The primary objective was to evaluate Audit of Diabetes-Dependent Quality of Life (ADDQoL) scores.

Results At baseline, the liraglutide group was younger and had shorter type 2 diabetes duration, lower glycated hemoglobin (HbA1c), higher body mass index, and a lower prevalence of certain diabetes-related complications than the insulin group (all p<0.05). ADDQoL average weighted impact scores improved numerically in both groups from baseline to 52 weeks (mean difference [95% confidence interval], liraglutide vs. insulin: 0.159 [−0.023;0.340]; not significant). Changes in general wellbeing and five ADDQoL domains significantly favored liraglutide (remaining 14 domains, not significant). HbA1c reductions were greater with insulin than liraglutide (−2.0% vs. −1.2%; p<0.01); however, mean HbA1c after 52 weeks was 7.2% in both groups. Compared with insulin, liraglutide significantly decreased body mass index (−1.54 kg/m2 vs. +0.27 kg/m2; p<0.001), systolic blood pressure (−5.03 mmHg vs. −1.03 mmHg; p<0.01) and non-severe hypoglycemia (0.85% vs. 4.55% at 52 weeks; p<0.01). Adverse drug reactions were reported for<3% of patients in both groups.

Conclusions Liraglutide improved certain ADDQoL components and reduced body mass index, systolic blood pressure, and non-severe hypoglycemia versus insulin. Both treatments improved glycemic control.

Supporting Information

 
  • References

  • 1 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2015; 58: 429-442
  • 2 Garber AJ, Abrahamson MJ, Barzilay JI. et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2018 executive summary. Endocr Pract 2018; 24: 91-120
  • 3 Meier JJ. GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat Rev Endocrinol 2012; 8: 728-742
  • 4 American Diabetes Association. 2018 Standards of medical care in diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 01) S1-S159
  • 5 Victoza Summary of Product Characteristics. February 2018. www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001026/WC500050017.pdf (last accessed 7 March 2018)
  • 6 Nauck MA. Liraglutide, a once-daily human GLP-1 analogue. Br J Diabetes Vasc Dis 2008; 8: S26-S33
  • 7 Marre M, Shaw J, Brändle M. et al Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med 2009; 26: 268-278
  • 8 Nauck M, Frid A, Hermansen K. et al. Long-term efficacy and safety comparison of liraglutide, glimepiride and placebo, all in combination with metformin in type 2 diabetes: 2-year results from the LEAD-2 study. Diabetes Obes Metab 2013; 15: 204-212
  • 9 Garber A, Henry RR, Ratner R. et al. Liraglutide, a once-daily human glucagon-like peptide 1 analogue, provides sustained improvements in glycaemic control and weight for 2 years as monotherapy compared with glimepiride in patients with type 2 diabetes. Diabetes Obes Metab 2011; 13: 348-356
  • 10 Zinman B, Gerich J, Buse JB. et al Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care 2009; 32: 1224-1230
  • 11 Russell-Jones D, Vaag A, Schmitz O. et al. Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): a randomised controlled trial. Diabetologia 2009; 52: 2046-2055
  • 12 Buse JB, Rosenstock J, Sesti G. et al. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet 2009; 374: 39-47
  • 13 Pratley R, Nauck M, Bailey T. et al. One year of liraglutide treatment offers sustained and more effective glycaemic control and weight reduction compared with sitagliptin, both in combination with metformin, in patients with type 2 diabetes: a randomised, parallel-group, open-label trial. Int J Clin Pract 2011; 65: 397-407
  • 14 Pratley RE, Nauck MA, Bailey T. et al. Efficacy and safety of switching from the DPP-4 inhibitor sitagliptin to the human GLP-1 analog liraglutide after 52 weeks in metformin-treated patients with type 2 diabetes: a randomized, open-label trial. Diabetes Care 2012; 35: 1986-1993
  • 15 Ahmann A, Rodbard HW, Rosenstock J. et al. Efficacy and safety of liraglutide versus placebo added to basal insulin analogues (with or without metformin) in patients with type 2 diabetes: a randomized, placebo-controlled trial. Diabetes Obes Metab 2015; 17: 1056-1064
  • 16 Marso SP, Daniels GH, Brown-Frandsen K. et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311-322
  • 17 Fonseca VA, Devries JH, Henry RR. et al. Reductions in systolic blood pressure with liraglutide in patients with type 2 diabetes: insights from a patient-level pooled analysis of six randomized clinical trials. J Diabetes Complications 2014; 28: 399-405
  • 18 Nationale VersorgungsLeitlinie. Therapie des Typ-2-Diabetes. November 2014.www.awmf.org/uploads/tx_szleitlinien/nvl-001gl_ S3_Typ-2-Diabetes-Therapie_2014-11.pdf (last accessed 7 March 2018)
  • 19 Bradley C, Todd C, Gorton T. et al. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res 1999; 8: 79-91
  • 20 Bradley C. The ADDQoL 19 – an individualised measure of the impact of diabetes on quality of life (user guideline, 01/03/2006). http://www.healthpsychologyresearch.com/guidelines/addqol19-audit-diabetesdependent-quality-life-0 (last accessed 7 March 2018)
  • 21 Seaquist ER, Anderson J, Childs B. et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013; 36: 1384-1395
  • 22 Emerging Risk Factors Collaboration. Sarwar N, Gao P, Seshasai SR. et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-2222
  • 23 Guh DP, Zhang W, Bansback N. et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009; 9: 88
  • 24 Inzucchi SE, Bergenstal RM, Buse JB. et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012; 55: 1577-1596
  • 25 Hall GC, McMahon AD, Dain MP. et al. Primary-care observational database study of the efficacy of GLP-1 receptor agonists and insulin in the UK. Diabet Med 2013; 30: 681-686
  • 26 Shah S, Zilov A, Malek R. et al. Improvements in quality of life associated with insulin analogue therapies in people with type 2 diabetes: results from the A1chieve observational study. Diabetes Res Clin Pract 2011; 94: 364-370
  • 27 Gautier JF, Martinez L, Penfornis A. et al. Effectiveness and persistence with liraglutide among patients with type 2 diabetes in routine clinical practice--EVIDENCE: a prospective, 2-year follow-up, observational, post-marketing study. Adv Ther 2015; 32: 838-853
  • 28 Ishii H, Niiya T, Ono Y. et al. Improvement of quality of life through glycemic control by liraglutide, a GLP-1 analog, in insulin-naive patients with type 2 diabetes mellitus: the PAGE1 study. Diabetol Metab Syndr 2017; 9: 3
  • 29 Diamant M, Nauck MA, Shaginian R. et al. 4B Study Group. Glucagon-like peptide 1 receptor agonist or bolus insulin with optimized basal insulin in type 2 diabetes. Diabetes Care 2014; 37: 2763-2773
  • 30 Yu M, Van Brunt K, Varnado OJ. et al. Patient-reported outcome results in patients with type 2 diabetes treated with once-weekly dulaglutide: data from the AWARD phase III clinical trial programme. Diabetes Obes Metab 2016; 18: 419-424
  • 31 Yabe D, Kuwata H, Usui R. et al. Glucagon-like peptide-1 receptor agonist therapeutics for total diabetes management: assessment of composite end-points. Curr Med Res Opin 2015; 31: 1267-1270
  • 32 Buysschaert M, D'Hooge D, Preumont V. et al ROOTS: a multicenter study in Belgium to evaluate the effectiveness and safety of liraglutide (Victoza®) in type 2 diabetic patients. Diabetes Metab Syndr 2015; 9: 139-142
  • 33 Nauck M, Frid A, Hermansen K. et al. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care 2009; 32: 84-90
  • 34 Mezquita-Raya P, Reyes-Garcia R, Moreno-Perez O. et al. Clinical effects of liraglutide in a real-world setting in Spain: eDiabetes-Monitor SEEN Diabetes Mellitus Working Group Study. Diabetes Ther 2015; 6: 173-185
  • 35 Nauck M, Vaag A, Colagiuri S et al. HbA1c reduction with liraglutide in patients with type 2 diabetes is associated with initial HbA1c levels. International Diabetes Federation 2009 20th World Congress Abstract Book. International Diabetes Federation, Montreal, Canada. 2009; 472 (abstract P-1400)
  • 36 Adler AI, Stratton IM, Neil HA. et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 321: 412-419
  • 37 Wing RR, Lang W, Wadden TA. et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011; 34: 1481-1486
  • 38 Zhang P, Hire D, Espeland MA. et al. Impact of intensive lifestyle intervention on preference-based quality of life in type 2 diabetes: results from the Look AHEAD trial. Obesity (Silver Spring) 2016; 24: 856-864
  • 39 Niswender K, Pi-Sunyer X, Buse J. et al. Weight change with liraglutide and comparator therapies: an analysis of seven phase 3 trials from the liraglutide diabetes development programme. Diabetes Obes Metab 2013; 15: 42-54
  • 40 Kragh N, Nauck MA, Mann JFE. et al. Health status assessed with EQ-5D in people with type 2 diabetes participating in the LEADER trial. Diabetic Medicine 2017; 34 Suppl. s1 36-194 (abstract P152)
  • 41 Zinman B, Wanner C, Lachin JM. et al. EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117-2128
  • 42 Neal B, Perkovic V, Mahaffey KW. et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377: 644-657
  • 43 Marso SP, Bain SC, Consoli A. et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375: 1834-1844
  • 44 American Diabetes Association. Standards of Medical Care in Diabetes—2017. Diabetes Care 2017; 40 (Suppl. 01) S1-S135
  • 45 Victoza Highlights of Prescribing Information. August 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf (last accessed 7 March 2018)
  • 46 Simon D, de Pablos-Velasco P, Parhofer KG. et al. Hypoglycaemic episodes in patients with type 2 diabetes--risk factors and associations with patient-reported outcomes: The PANORAMA Study. Diabetes Metab 2015; 41: 470-479
  • 47 Meneghini LF, Lee LK, Gupta S. et al. Association of hypoglycaemia severity with clinical, patient-reported and economic outcomes in US patients with type 2 diabetes using basal insulin. Diabetes Obes Metab 2018; DOI: 10.1111/dom.13208. [Epub ahead of print]
  • 48 Davies M, Pratley R, Hammer M. et al. Liraglutide improves treatment satisfaction in people with type 2 diabetes compared with sitagliptin, each as an add on to metformin. Diabet Med 2011; 28: 333-337
  • 49 Freemantle N, Meneghini L, Christensen T. et al. Insulin degludec improves health-related quality of life (SF-36®) compared with insulin glargine in people with type 2 diabetes starting on basal insulin: a meta-analysis of phase 3a trials. Diabet Med 2013; 30: 226-232