Diabetes: Use liraglutide with care

05.10.2009 15:01

The professional association of specialized diabetological practices in North Rhine-Westphalia (BdSN) only recommends the new drug liraglutide under certain conditions

Liraglutide has been on the market in Germany and Great Britain since July. The BdSN considers treatment with the new diabetes drug liraglutide to be useful “for certain diabetes patients”. The professional association points out that the active ingredient should be prescribed under certain conditions in order to have a positive effect. “Patients who are well adjusted to their current medications have no reason to change medications now,” said Dr. Ulrich Nühlen from BdSN.

Since the drug is new, nothing is known about long-term side effects. A few 1,000 patients were observed in the studies, but only over a period of six months to a maximum of two years. Therefore, Dr. Nühlen, select patients for treatment with liraglutide very carefully and observe them closely in order to gain further insights.

Liraglutide – not an insulin replacement

In principle, the active ingredient is only suitable for type 2 diabetics who are already taking tablets for diabetes and do not yet need insulin. “Some patients believe they can simply switch to liraglutide and then never need to inject insulin again. However, this is a misconception,” said Dr. Matthias Riedel, “Liraglutide is not an insulin replacement.”

The active ingredient ensures that insulin is only released when blood sugar is elevated. As a result, the medication not only lowers blood sugar levels, but also reduces the risk of high or low blood sugar. Because liraglutide works over a relatively long period of time, diabetics only need to inject it under the skin once a day. In the long term, the preparation can reduce long-term sugar levels (HBA1c) by up to 1.2 percentage points. Studies carried out to test the new medication have shown that side effects such as nausea or diarrhea often occur, which usually subside over the course of treatment.

The new drug is also currently not approved for combination with insulin. In a few years, however, this combination could prove to be effective following appropriate studies. Due to a lack of experience, liraglutide should be prescribed cautiously in patients with heart failure or inflammatory bowel disease. The medication should also not be used in cases of stomach paralysis. If symptoms of pancreatitis occur, liraglutide should be discontinued.

Prescribe liraglutide for obese patients

Since liraglutide is relatively expensive compared to other diabetes medications, for financial reasons it can only be prescribed to overweight diabetics who would have to switch to insulin without the new preparation and would be dependent on very high doses due to their weight. Liraglutide can have an additional positive effect here, as the active ingredient causes a feeling of satiety, which can lead to weight loss.

Dr. Nühlen points out that the new drug is by no means a miracle cure for obesity: “In the studies, patients lost up to two percent of their body weight. Lifestyle changes are also essential with liraglutide. This includes, above all, more exercise and a balanced diet.” In practice, significantly greater weight loss was also evident.