Liraglutide, a once-daily glucagon-like peptide-1 (GLP-1) receptor agonist, was compared to twice-daily exenatide in a 26-week randomized, open-label trial involving adults with inadequately controlled type 2 diabetes. This study evaluated the efficacy and safety of both treatments in patients already on maximally tolerated doses of metformin, a sulfonylurea, or a combination of both.
Study Design and Methodology
This multinational study, spanning 15 countries, enrolled adults with type 2 diabetes inadequately controlled by existing oral antidiabetic medications. Participants were randomly assigned to receive either 1.8 mg of liraglutide once daily or 10 mcg of exenatide twice daily, in addition to their current treatment regimen. The primary outcome measure was the change in glycosylated hemoglobin (HbA1c) from baseline to 26 weeks. Analyses were conducted on an intention-to-treat basis. The trial was registered with ClinicalTrials.gov (NCT00518882).
Superior Glycemic Control with Liraglutide
At baseline, the mean HbA1c was 8.2% across the study population. Results from the 26-week randomized open-label trial compared liraglutide once daily to exenatide twice daily demonstrated a statistically significant reduction in HbA1c with liraglutide (-1.12%) compared to exenatide (-0.79%). This difference of -0.33% (95% CI -0.47 to -0.18; p<0.0001) highlights the superior efficacy of liraglutide in improving glycemic control. Furthermore, a significantly higher proportion of patients treated with liraglutide achieved an HbA1c level below 7% (54% vs. 43%; odds ratio 2.02; 95% CI 1.31 to 3.11; p=0.0015). Liraglutide also demonstrated superior fasting plasma glucose reduction compared to exenatide.
Weight Loss and Tolerability
Both liraglutide and exenatide facilitated clinically meaningful weight loss, with average reductions of 3.24 kg and 2.87 kg, respectively. While both treatments were generally well-tolerated, liraglutide demonstrated a more favorable safety profile. Notably, persistent nausea was significantly less frequent with liraglutide (estimated treatment rate ratio 0.448, p<0.0001). The incidence of minor hypoglycemia was also lower in the liraglutide group (1.93 events per patient per year vs. 2.60 events; rate ratio 0.55; 95% CI 0.34 to 0.88; p=0.0131). Two patients in the exenatide group experienced major hypoglycemic episodes while also taking a sulfonylurea.
Conclusion: Liraglutide a Promising Option for Type 2 Diabetes Management
This 26-week randomized open-label trial compared liraglutide once daily administration to twice-daily exenatide and found that liraglutide provided superior glycemic control and a more favorable safety profile, particularly regarding nausea and hypoglycemia. These findings suggest that liraglutide may be a valuable treatment option for individuals with type 2 diabetes, especially when weight loss and minimizing hypoglycemia risk are key considerations. The once-daily dosing regimen of liraglutide offers a potential advantage in terms of patient convenience and adherence.
