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  • Adding subcutaneous liraglutide to metformin reduces HbA1c more than adding oral sitagliptin in patients whose type 2 diabetes is poorly controlled with metformin alone

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Therapeutics
Randomised controlled trial
Adding subcutaneous liraglutide to metformin reduces HbA1c more than adding oral sitagliptin in patients whose type 2 diabetes is poorly controlled with metformin alone
  1. Vivian Fonseca1,
  2. Cyrus Desouza2,
  3. Amna N Khan1
  1. 1Tulane University Health Sciences Center, New Orleans, Louisiana, USA
  2. 2Omaha VA Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Vivian Fonseca
    Tulane University Health Sciences Center, 1430 Tulane Ave, SL-53, New Orleans, LA 70112, USA; vfonseca{at}tulane.edu

https://doi.org/10.1136/ebm1098

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    Commentary on:

    1. Pratley RE,
    2. Nauck M,
    3. Bailey T,
    4. et al
    .; 1860-LIRA-DPP-4 Study Group. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin: a 26-week, randomised, parallel-group, open-label trial. Lancet 2010;375:1447–56.
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    Context

    Incretin hormones have recently been recognised in playing an important role in the pathogenesis and treatment of type 2 diabetes.1 Of these, glucagon-like peptide (GLP-1) is probably the most important but has a limitation due to its rapid breakdown by the enzyme dipeptidyl peptidase 4 (DPP-4) giving it a half life in circulation of approximately 2 min.

    To overcome this limitation, two pharmacological approaches have been developed: (1) DPP-4 inhibitors (sitagliptin, saxagliptin) that increase the endogenous concentrations of GLP-1 through inhibition of DPP-4 and (2) GLP-1 mimetics (exenantide) or analogues (liraglutide). The former have the advantage of being taken orally whereas the latter are injectable. Previous studies have all focused on comparing incretin-based treatments to other medications such as sulphonylureas, metformin, thiazolidinediones or insulin.2 3 There are very few studies comparing one form of incretin therapy to …

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    Footnotes

    • Competing interests VF has received consultancy fees, lecture fees and grants from Glaxo Smith Kline, Novartis, Novo-Nordisk, Takeda, Astra-Zeneca, Sanofi-Aventis, Eli Lilly, Daiichi-Sankyo, Novartis, NIH, ADA. CD has received consultancy fees from Novo Nordisk and Takeda. ANK is an investigator in the TECOS trial funded by Merck.