Effect of Liraglutide on Metabolic and Renal Outcomes Over 12 Months in Community Diabetic Nephropathy Clinics

Abstract

Liraglutide is an effective agent for improved glycemic control and weight loss, but its safety and effectiveness in patients with diabetic nephropathy has not been established. Our goal was to examine the impact of liraglutide on metabolic and renal outcomes in patients with diabetic nephropathy in a community setting. Thirty-eight type 2 diabetic subjects (mean age 56 [39 to 73] years, duration 11 [1 to 30] years) with diabetic nephropathy on ACEI or ARB therapy (mean±sd: eGFR 76±25 mL/min, median ACR 3.3 (range 0.3 to 388) mg/mmol) and taking oral antihyperglycemic agents (1.6±0.6 agents) were studied. Twenty-two of 38 subjects were also using insulin (0.84±0.47 u/kg/day). Weight and A1C were assessed at initiation and 1-year post liraglutide. ACR and eGFR (abbreviated MDRD) were assessed at the same time points and 1 year prior to liraglutide. There were no significant changes in eGFR or ACR (Figure 1) in the year prior to or the year following liraglutide therapy. A1C improved in 25/38 subjects (mean –0.7±1.4%, p<0.004), 13/38 achieved A1C <7% and 30/38 subjects lost weight (mean –5.1±5 kg, p<0.001). There were reductions in both oral antihyperglycemic drug (1.45±0.7 agents, p<0.004) and insulin use (0.67±0.43 u/kg/day, p<0.005). The beneficial metabolic effects of liraglutide were sustained over 12 months in subjects with diabetic nephropathy with no evidence of negative consequences for renal function or markers of diabetic nephropathy. These data provide reassurance for clinicians managing patients with diabetic nephropathy.