GLP-1 Agonists in Type 1 Diabetes Mellitus

Ann Pharmacother. 2016 Aug;50(8):656-65. doi: 10.1177/1060028016651279. Epub 2016 Jun 1.

Abstract

Objective: To review the use of GLP-1 agonists in patients with type 1 diabetes mellitus (T1DM).

Data sources: A search using the MEDLINE database, EMBASE, and Cochrane Database was performed through March 2016 using the search terms glucagon-like peptide 1 (GLP-1) agonists, incretin, liraglutide, exenatide, albiglutide, dulaglutide, type 1 diabetes mellitus

Study selection and data extraction: All English-language trials that examined glycemic end points using GLP-1 agonists in humans with T1DM were included.

Data synthesis: A total of 9 clinical trials examining the use of GLP-1 agonists in T1DM were identified. On average, hemoglobin A1C (A1C) was lower than baseline, with a maximal lowering of 0.6%. This effect was not significant when tested against a control group, with a relative decrease in A1C of 0.1% to 0.2%. In all trials examined, reported hypoglycemia was low, demonstrating no difference when compared with insulin monotherapy. Weight loss was seen in all trials, with a maximum weight loss of 6.4 kg over 24 weeks. Gastrointestinal adverse effects are potentially limiting, with a significant number of patients in trials reporting nausea.

Conclusion: The use of GLP-1 agonists should be considered in T1DM patients who are overweight or obese and not at glycemic goals despite aggressive insulin therapy; however, tolerability of these agents is a potential concern. Liraglutide has the strongest evidence for use and would be the agent of choice for use in overweight or obese adult patients with uncontrolled T1DM.

Keywords: GLP-1 agonists; albiglutide; diabetes; dulaglutide; exenatide; liraglutide; type 1 diabetes.

Publication types

  • Review

MeSH terms

  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Exenatide
  • Glucagon-Like Peptide 1 / administration & dosage
  • Glucagon-Like Peptide 1 / adverse effects
  • Glucagon-Like Peptide 1 / agonists*
  • Glucagon-Like Peptide 1 / analogs & derivatives
  • Glucagon-Like Peptide 1 / therapeutic use*
  • Glucagon-Like Peptides / administration & dosage
  • Glucagon-Like Peptides / adverse effects
  • Glucagon-Like Peptides / analogs & derivatives
  • Glucagon-Like Peptides / therapeutic use
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Immunoglobulin Fc Fragments / administration & dosage
  • Immunoglobulin Fc Fragments / adverse effects
  • Immunoglobulin Fc Fragments / therapeutic use
  • Incretins / administration & dosage
  • Incretins / adverse effects
  • Incretins / therapeutic use
  • Liraglutide / administration & dosage
  • Liraglutide / adverse effects
  • Liraglutide / therapeutic use
  • Peptides / administration & dosage
  • Peptides / adverse effects
  • Peptides / therapeutic use
  • Recombinant Fusion Proteins / administration & dosage
  • Recombinant Fusion Proteins / adverse effects
  • Recombinant Fusion Proteins / therapeutic use
  • Venoms / administration & dosage
  • Venoms / adverse effects
  • Venoms / therapeutic use

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Immunoglobulin Fc Fragments
  • Incretins
  • Peptides
  • Recombinant Fusion Proteins
  • Venoms
  • rGLP-1 protein
  • Glucagon-Like Peptides
  • Liraglutide
  • Glucagon-Like Peptide 1
  • Exenatide
  • dulaglutide