Liraglutide is a long-acting GLP-1 analogue, which was developed by Novo Nordisk company. It is one of the most popular hypoglycemic drugs in the past ten years. Today, we will briefly summarize the clinical experience of many years.
Lowering blood sugar
After 2 weeks of use, it has obvious hypoglycemic effect, and can reduce glycosylated hemoglobin by about 1.1-2.5% on average. The duration of action is 24 hours. It can improve blood glucose control by reducing fasting and postprandial blood glucose in patients with type 2 diabetes, but mainly reducing postprandial blood glucose. It can reduce the blood glucose after three meals by 1.5-3 mmol / L or 0.7-2 mmol / L.
It can improve the function of β – cell and insulin secretion in the first and second phase. Hypoglycemia is glucose concentration dependent. That is to say, the hypoglycemic effect can only be exerted when the blood glucose level is increased, but it will not be further reduced when the blood glucose level is normal. That is to say, it has intelligent hypoglycemic effect, and hypoglycemia is less.
Weight loss effect
Inhibition of gastric emptying and control of appetite, reduce food intake, reduce hunger and increase satiety, eventually leading to weight loss. The first reaction of many patients is the reduction of waist circumference, and then weight loss, which can effectively reduce the waist circumference by about 2.5cm.
Weight loss is generally about 2-3kg. The degree of weight loss is positively correlated with individual weight before taking medicine. Generally, the heavier the weight, the more weight loss. Weight loss can be seen within 2 weeks, and it is more common to lose 2-3 kg within 3 months. There are also more sensitive to drugs, used up to 10 kg weight loss. I found that the more severe the gastrointestinal reaction, the lighter the weight.
Lowering blood pressure
The systolic pressure drop was 2.6-3.3 mmHg. Hypertension patients with diabetes basically maintain the original use of antihypertensive drugs, a small number of individual patients with decreased blood pressure can reduce the amount of antihypertensive drugs.
Cardiovascular benefits
Clinical studies have shown that liraglutide can significantly reduce the risk of cardiovascular events, especially for T2DM patients with cardiovascular disease. It is also the second hypoglycemic drug with definite cardiovascular benefits after empa-reg outcom. Liraglutide can significantly reduce mace risk by 13%, cardiovascular death risk by 22%, extended mace risk by 12% and all-cause death risk by 15%. Liraglutide can bring comprehensive benefits to T2DM patients in terms of clinical, metabolic and microvascular outcomes;
Hypoglycemia:
The incidence of single use was low. Because of the unique concentration dependent hypoglycemic effect, the incidence of hypoglycemia is very low. If combined with sulfonylureas, it may increase the risk of hypoglycemia.
Adverse reactions
The main gastrointestinal reactions were nausea, vomiting, diarrhea, abdominal pain, loss of appetite and abdominal discomfort. The most common adverse reactions are gastrointestinal discomfort: nausea and diarrhea are more common, many patients will have vomiting, constipation, abdominal pain and indigestion.
Characteristics: most of the events were mild to moderate, and were dose-dependent, that is to say, the higher the dose, the higher the incidence of adverse reactions. And the older the age, the higher the incidence of gastrointestinal reactions. The worse the renal function, the higher the incidence of gastrointestinal reactions
The frequency of these gastrointestinal adverse reactions will be higher at the beginning of use. With the extension of time, the treatment will continue for several days or weeks and gradually reduce.
Use for special groups:
Patients with impaired renal function: Patients with mild or moderate impaired renal function (creatinine clearance rates of 60-90 ml / min and 30-59 ml / min, respectively) do not need dose adjustment. At present, it is not recommended for patients with severe renal impairment including end stage renal disease
Patients with liver function damage: mild to moderate liver function damage can be used, do not need to adjust the dose. It is not recommended for patients with severe liver dysfunction.
Highlights
In order to improve gastrointestinal tolerance, liraglutide was started at a low dose of 0.6 mg per day.
After at least one week, the dose should be increased to 1.2mg. It is expected that some patients will benefit from increasing the dose from 1.2mg to 1.8mg. According to the clinical response, in order to further improve the hypoglycemic effect, the dose can be increased to 1.8mg after at least one week. The recommended daily dose is not more than 1.8 mg.
Pay attention to the contraindications. The specialist should make a comprehensive evaluation of the patient and decide whether to use it or not. It is not recommended that the patient buy it privately.