963-P: A Randomized Controlled Trial Comparing Liraglutide vs. Glargine Insulin for the Management of Patients with Type 2 Diabetes after Hospital Discharge

Abstract

Limited studies have compared diabetes treatment regimens during the transition from the inpatient to outpatient setting. This RCT compared the safety and efficacy of liraglutide with glargine U100 in general medicine and surgery patients with T2D at hospital discharge. A total of 227 patients with HbA1c 7-10%, treated at home with diet, oral agents, or insulin at a total daily dose ≤0.4 units/kg were randomized to liraglutide (1.8mg/day) or glargine. The primary efficacy endpoint was difference in HbA1c at 12 and 26 weeks. Secondary endpoints included changes in weight, postprandial glucose, hypoglycemia, achievement of HbA1c <7% without hypoglycemia or weight gain, gastrointestinal adverse events, and emergency department (ED) visits or hospital readmissions. Baseline characteristics were similar in the liraglutide and glargine groups (baseline HbA1c: 8.3±0.8 and 8.0±0.9%, respectively). We observed no differences in HbA1c at 12 weeks [7.1± 1.1 vs. 7.4± 1.3%, p=0.20; estimated treatment difference (ETD): -0.26%, 95% CI: -0.62, 0.10%] or 26 weeks (7.1±1.3 vs. 7.5±1.6%, p=0.13, ETD: 0.39%, 95% CI -0.89, 0.10%), respectively. Weight change at 26 weeks was greater with liraglutide (-5.3 vs.-0.4kg, p= 0.002). Postprandial glucose levels were lower with liraglutide at 12 weeks but not at 26 weeks. Liraglutide resulted in less hypoglycemia < 70 mg/dl (16 vs. 27%, p=0.04). A higher proportion of patients achieved HbA1c<7% without hypoglycemia and without weight gain at 26 weeks (45 vs. 24%, p=0.01) with liraglutide. Gastrointestinal adverse events were higher with liraglutide (21 vs. 0%, p<0.001). There were no differences in ED visits or hospital readmissions between groups. In summary, the use of liraglutide after hospital discharge is associated with similar change in HbA1c compared to glargine. Liraglutide treatment resulted in less hypoglycemia, greater weight reduction, with expected increased gastrointestinal adverse events. Disclosure F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp & Dohme Corp., National Institutes of Health. M.A. Urrutia: None. S. Cardona: None. G. Iacobellis: None. J. Farias: None. A. Chaudhuri: Consultant; Self; Bayer U.S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. I. Anzola: None. J.D. Palacios: None. B.S. Albury: None. P.C. Gomez: None. K.W. Zamudio: None. M.C. Perez-Guzman: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Fayfman: None. J. Haw: None. R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. G. Davis: None. A. Migdal: None. L. Peng: None. G.E. Umpierrez: None. Funding Novo Nordisk