Type 2 Diabetes Mellitus Clinical Trial
Official title:
The Effect of Liraglutide on Insulin-associated wEight GAiN in Patients With Type 2 Diabetes Mellitus (ELEGANT Trial)
Insulin therapy is frequently needed to achieve adequate glycaemic control in type 2
diabetes. Although insulin is an effective treatment modality, this is often at the expense
of significant weight gain. Weight gain is obviously undesirable in an already overweight
population, but may also deter further optimization of insulin therapy. Large
inter-individual differences exist in the level of weight gain after initiation of insulin
therapy, but no clear predictive factors have prospectively been identified thus far.
Liraglutide (Victoza®), a human glucagon-like peptide-1 (GLP-1) analogue, improves glycaemic
control and reduces weight. We hypothesize that in patients who show (excessive) weight gain
after introducing insulin therapy, adding liraglutide is effective in reversing body weight
while preserving glycaemic control.
Patients with type 2 diabetes mellitus on short-term (≤ 12 months) insulin therapy with
concomitant documented weight gain of ≥ 4 % body weight will be selected and treated with
liraglutide 1.8 mg sc q.d. for 26 weeks and compared to patients receiving standard care
(continuation of insulin therapy without liraglutide) in an open-label, randomized study.
After 26 weeks, patients receiving standard care will subsequently be treated with
liraglutide for 26 weeks. The group on active liraglutide treatment will continue for an
additional 26 weeks. In this way all patients can benefit from liraglutide.
All subjects will continue insulin therapy and oral hypoglycaemic agents (SU derivatives and
metformin allowed) treatment. With respect to safety in order to avoid hypoglycaemic events,
total insulin dose will be decreased by 20% when starting liraglutide. Within the first
weeks after start of study medication patients will perform frequently self-measured
capillary blood glucose profiles and will be instructed to adjust insulin dose if necessary.
Initially, insulin dose will be adjusted weekly by telephone consultation. Thereafter,
patients will perform blood glucose profiles prior to every outpatient visit. A
liraglutide-insulin titration algorithm will be used to adjust insulin dose. Every 4-6 weeks
patients will visit the hospital to assess body weight, to adjust insulin dose and to check
for adverse events.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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