GLP-1 analogue use in patients with sub-optimally controlled type 1 diabetes or obesity improves weight and HbA1c

Abstract

GLP-1 analogues are licensed for add-on therapy for patients with type 2 diabetes who have sub-optimal glycaemic control on other glucose lowering agents. Their use in patients with type 1 diabetes has been evaluated in primarily research settings. We investigated the effect of adding GLP-1 analogues on weight and glycaemic control in our patients with type 1 diabetes. A retrospective observational case note review of patients with type 1 diabetes between 2011 and 2014 was performed to recruit patients to this study. Inclusion criteria were established treatment with multiple daily injections or continuous subcutaneous insulin infusion and sub-optimal glycaemic control (HbA1c >57 mmol/mol) or obesity (BMI >30 kg/m2). A GLP-1 analogue was added to pre-existing treatment. HbA1c and weight were measured at initiation and six monthly for up to 30 months. Thirty-three patients were included. The addition of a GLP-1 analogue significantly improved mean HbA1c from baseline at 6, 12 and 30 months (79 mmol/mol, 71 mmol/mol, 70 mmol/mol, 74 mmol/mol; all p < 0.05); and weight from baseline at 6, 12, 18, 24 and 30 months (104.9 kg, 98.0 kg, 98.5 kg, 94.7 kg, 96.2 kg, 92.0 kg; all p < 0.05). Patients with BMI <35 kg/m2 had an improved response in both weight and HbA1c over those with BMI ≥35 kg/m2. Three patients discontinued treatment due to gastrointestinal side effects. In conclusion, the addition of a GLP-1 analogue to existing treatment resulted in significantly improved glycaemic control and weight loss in patients with type 1 diabetes.