liraglutide hospital discharge trial

Conditions: Type 2 Diabetes

Summary: high blood glucose levels in hospitalized patients with diabetes are associated with increased risk of medical complications and death. improved glucose control with insulin injections may improve clinical outcome and prevent some of the hospital complications. increasing evidence indicates that incretin-based agents are safe and effective for the hospital management of patients with type 2 diabetes (t2d). liraglutide is a once-daily human glucagon-like peptide (glp-1) analogue approved for the treatment of t2d. liraglutide has been shown to lower blood glucose, stimulate endogenous insulin secretion, decrease plasma glucagon levels, inhibit gastric emptying, reduce food intake and body weight and improve ß-cell function when administered subcutaneously. liraglutide increases insulin secretion in a glucose-dependent manner (i.e., only when plasma glucose levels are elevated), resulting in low-risk of hypoglycemia when used as monotherapy. when compared to insulin glargine therapy, the use of glp-1 has resulted in comparable reduction in hba1c level, lower rates of hypoglycemia and less weight gain. no prospective studies; however, have compared the efficacy and safety of liraglutide in the hospital setting or after hospital discharge. the primary objective is to compare the safety and efficacy of liraglutide (victoza®) versus glargine insulin in combination to oral anti-diabetic agents (oads: metformin, sulfonylureas, nateglinide, repaglinide or pioglitazone) on glycemic control after 26 weeks of treatment in medicine patients with t2d after hospital discharge.

specific aim: to determine whether treatment with liraglutide (victoza®) will result in similar glycemic control (hba1c at 26 weeks) and a lower rate of hypoglycemic events compared to treatment with glargine (lantus®) in patients with t2d after hospital discharge. patients with poorly controlled (hba1c \>7%-10%) t2d treated with diet or oral antidiabetic agents or low dose insulin naïve (0.4u/kg/day) prior to admission will be randomized to liraglutide or glargine in combination to oads at hospital discharge.

Eligibility criteria:
inclusion criteria: 1. males or females between the ages of 18 and 80 years discharged after hospital admission from non- icu general surgery and medicine services (excluding gastrointestinal and cardiac surgeries). 2. admission hba1c between 7% and 10% 3. patients with t2d treated with diet alone or with oral antidiabetic agents as monotherapy or in combination therapy (excluding glp1 receptor agonists) or on low-dose insulin therapy (tdd ≤0.4 unit/kg/day) prior to admission. 4. subjects with a hospital admission bg \< 400 mg/dl without laboratory evidence of diabetic ketoacidosis (serum bicarbonate \< 18 meq/l or positive serum or urinary ketones). 5. bmi \> 25 kg/m2 and ≤ 45 kg/m2 exclusion criteria: 1. age \ 80 years. 2. subjects with stress hyperglycemia (bg \> 140 mg/dl and hba1c \< 6.5%) 3. subjects with a history of type 1 diabetes 4. treatment with insulin or glp-1 analogs during the past 3 months prior to admission. 5. recurrent severe hypoglycemia or hypoglycemic unawareness. 6. subjects with gastrointestinal obstruction, gastroparesis, or those expected to require gastrointestinal suction. 7. history of medullary thyroid cancer or multiple endocrine neoplasias 8. patients with acute or chronic pancreatitis, pancreatic cancer, or gallbladder disease. 9. patients with clinically significant hepatic disease (cirrhosis, jaundice, end-stage liver disease, portal hypertension) and elevated alt and ast \> 3 times upper limit of normal, or significantly impaired renal function (gfr \< 30 ml/min). 10. treatment with oral or injectable corticosteroid (equivalent or higher than prednisone 5mg/day), parenteral nutrition, and immunosuppressive treatment. 11. mental condition rendering the subject unable to understand the nature, scope, and possible consequences of the study. 12. female subjects who are pregnant or breastfeeding at the time of enrollment into the study. 13. females of childbearing potential who are not using adequate contraceptive methods (as required by local law or practice).

Keywords: incretins liraglutide glargine randomized controlled trial basal insulin hospital discharge inpatient diabetes