Liraglutide – a newcomer in glucose-lowering drugs, not only lowering glucose, but also cardiovascular protection

Patients with type 2 diabetes are at high risk for cardiovascular disease. Among the current glucose-lowering drugs, some of them are not only effective in lowering glucose, but also have additional cardiovascular protective effects. The SGLT2 inhibitors, such as Dagliflozin and Engeljen, which Dr. Chen gave a scientific review of some time ago, are such drugs. The SGLT-2 inhibitors, a miracle drug for lowering blood sugar, have both glucose lowering and cardioprotective effects.

Today, Dr. Chen will give you another hypoglycemic drug, liraglutide. Liraglutide is not only good for lowering glucose, but also for lowering body weight and for cardiovascular protection.

A brief introduction to liraglutide

Liraglutide belongs to the class of GLP-1 receptor agonist glucose-lowering drugs, while other drugs include exenatide and lisdexamfetamine. This is because from the current studies, only the cardiovascular protective effects of liraglutide have been confirmed. Therefore, this article focuses on liraglutide.

Liraglutide is primarily used in the treatment of type 2 diabetes, either alone or in combination with other medications, such as metformin, sulfonylureas, and insulin.
Liraglutide is not a pill, but, like insulin, needs to be administered by subcutaneous injection.

Effects of Liraglutide

Glucose-lowering effect

1、Principle of hypoglycemia

Promotes the synthesis and secretion of insulin

Inhibition of glucagon secretion

Protects beta cells and increases the number of beta cells. (Beta cells are the cells in the pancreas responsible for producing insulin)

Reduces hepatic glycogen output. After a person eats, food breaks down into glucose into the bloodstream, of which 60-70% is converted in the liver into hepatic glycogen, where it is first stored. It is released for use when the body needs it.

Reduces appetite and increases satiety, thus reducing calorie intake

Delayed gastric emptying and peristalsis

2、Lowering sugar effect

Liraglutide 1.2 mg or 1.8 mg, administered subcutaneously once daily for 26 weeks, was shown to significantly reduce glycosylated hemoglobin (HbA1c) by 1.0% to 1.4%.

Another meta-analysis showed that liraglutide treatment lowered glycated hemoglobin by 1.18%.

Glycated hemoglobin is an indicator of the patient’s average level of glycemic control over the previous 3 months. The normal value is 4-6%.

Compared with other hypoglycemic agents, it is more effective than

sulfonylureas, sitagliptin phosphate, and glucagon insulin.

Weight reduction

Liraglutide reduces weight in 3 main ways:

(1) By increasing the level of hypothalamic satiety signals, it inhibits the increase of hunger signals, thus increasing satiety and reducing calorie intake.

(2) Increases energy expenditure. (3) Acting on the gastrointestinal tract, delaying gastric emptying and peristalsis.

Studies have shown that liraglutide 1.2 mg or 1.8 mg, injected subcutaneously once a day for 26 weeks, can significantly reduce body weight by 0.1-2.6 Kg.

Another meta-analysis showed that liraglutide treatment reduced body weight by 2.51Kg.

lower blood pressure

Liraglutide has a blood pressure-lowering effect, acting primarily on systolic blood pressure. Research shows that liraglutide can lower systolic blood pressure by 2.6-3.3mmHg in patients with type 2 diabetes for two weeks.

Regulation of blood lipids

Liraglutide significantly reduces postprandial triglyceride levels in patients with type 2 diabetes. Studies have shown that liraglutide can significantly reduce total cholesterol, triglycerides and LDL levels.

Cardiovascular Protection

Among the GLP-1 receptor agonists, only liraglutide has been shown to be cardioprotective. Studies have shown that in patients with type 2 diabetes associated with cardiovascular disease or cardiovascular risk, a 13% reduction in major cardiovascular endpoint events and a 22% reduction in the risk of cardiovascular death with no increased risk of heart failure can be achieved with conventional therapy compared to placebo.

Common adverse reactions to liraglutide

  1. Gastrointestinal reactions

The most common adverse reactions to liraglutide are gastrointestinal upset, including nausea, vomiting, diarrhea, abdominal pain, indigestion, and decreased appetite.

The majority of gastrointestinal reactions are mild to moderate and transient. However, there are some patients in the clinic who have had more severe gastrointestinal reactions after use, and gastrointestinal reactions vary from person to person.

The other day, I had two type 2 diabetic patients in my hands who happened to be one in bed 11 and one in bed 12. Both were on liraglutide at the same time, and one of them had no reaction at all in bed 11 and had a good appetite. Bed 12, however, had gastrointestinal reactions, diarrhea, indigestion, and loss of appetite. As the patient could not tolerate it, he finally had to give up liraglutide.

Liraglutide – the new noble among the hypoglycemic drugs, not only hypoglycemic, but also has a protective effect on cardiovascular.
Gastrointestinal reactions resolved.

On the one hand, liraglutide causes a dose-related gastrointestinal reaction; on the other hand, the symptoms decrease with longer treatment. Therefore, for people who have gastrointestinal reactions, you can start with a small dose and gradually increase the dose.

2、Low blood sugar

Liraglutide alone does not cause hypoglycemia, but in combination with sulfonylureas and insulin, it may cause hypoglycemia. In particular, patients who usually need to drive need to pay attention to prevent the occurrence of hypoglycemia when using liraglutide in combination.

3、Tumor of thyroid may occur.

Liraglutide may cause the development of thyroid C-cell tumors in rodents. However, it is not known whether thyroid C-cell tumors develop in humans after use.

However, the use of GLP-1 (liraglutide) does not increase the risk of medullary thyroid carcinoma according to many large published studies.

However, for safety reasons, it is contraindicated in individuals with a previous history of medullary thyroid cancer or a family history of medullary thyroid cancer.

4、Acute pancreatitis

According to published studies, it does not lead to an increased risk of acute pancreatitis in patients with standard doses of treatment. However, there have been instances where this has occurred during clinical use.

Therefore, individuals may be at risk of developing acute pancreatitis. For safety reasons, when a patient develops persistent, severe abdominal pain and acute pancreatitis is suspected, the drug should be discontinued. Use should not be resumed until it has been determined that it is due to some other cause.

Comparison of liraglutide with SGLT2 inhibitors
SGLT2 inhibitors, including dagliflozin and enegliflozin, have been discussed in previous articles. It is also the present day glucose-lowering medications and their brilliant presence inside. Both drugs are glucose-lowering drugs and both are able to lower body weight and blood pressure as well as have cardiovascular benefits. The following is a comparison of the effect of these two drugs in the end who is stronger.

1、Comparison in terms of glucose lowering

According to the study, SGLT2 inhibitors have similar glucose lowering effect as metformin, and can lower glycated hemoglobin by 0.5%-1.0%.

While liraglutide can significantly lower HbA1c by 1.0%-1.4%.

From the aspect of lowering glucose, it seems that the effect of liraglutide is better.

2、Reducing weight

SGLT2 inhibitors can reduce it by 1.5-3.5Kg.

Liraglutide can lower it by about 2.5Kg. It should be said that the effect of the two weight reduction is similar, depending on individual circumstances.

3、Lowering blood pressure

SGLT2 inhibitors reduce systolic blood pressure by 3-5 mmHg.

Two weeks of liraglutide action can lower systolic blood pressure by 2.6-3.3 mmHg in type 2 diabetes.

The effect of the two blood pressure lowering is also similar.

4、Cardiovascular protection

In terms of cardiovascular protection, since there is no head-to-head comparison between liraglutide and SGLT2 inhibitors, it’s not too easy to determine who is stronger. However, I personally feel that SGLT2 inhibitors are more effective.

SGLT2 inhibitors not only have a cardiovascular protective effect, but also reduce the risk of hospitalization in patients with heart failure.
In general, both drugs have their own advantages. They are similar in reducing weight and blood pressure. Liraglutide is more effective in lowering glucose levels and also regulates blood lipids, while SGLT2 inhibitors are better for cardiovascular protection, reducing hospitalization rates for heart failure and also have a protective effect on the kidneys.

Summing up.

GLP-1 receptor agonists are a very important class of new drugs in the field of type 2 diabetes treatment, and liraglutide is the leader in GLP-1. Not only is it effective in lowering glucose, it can also lower weight, blood pressure, blood lipids, and has a protective effect on cardiovascular, which can be said to be a gospel for type 2 diabetes patients.