This article in the Drug and Therapeutics Bulletin (DTB) assesses the evidence for the recently licensed long-acting glucagon-like peptide-1 (GLP-1) mimetic liraglutide (Victoza®), and considers whether it has a role in the management of patients with type 2 diabetes. The article covers the following topics:

• What is liraglutide?
• Clinical efficacy: vs. oral hypoglycaemics, exenatide, insulin
• Other effects: weight loss, systolic blood pressure, β-cell function,
• Unwanted effects
• Cautions
• Guidelines

The review notes that:

• Liraglutide reduces HbA1c levels by about 1% and is associated with modest weight loss (< 5% total body weight), but its effects on morbidity and mortality (if any) need to be demonstrated.

 • In common with exenatide, it causes unwanted GI effects, particularly nausea and diarrhoea.

 • Liraglutide is expensive and currently lacks long-term safety data.

The article concludes that at present, “liraglutide should be considered only after conventional oral hypoglycaemic therapy (including a glitazone) has failed, and where the avoidance of weight gain is crucial, insulin therapy is contraindicated, or the individual is unable to tolerate exenatide.”

[There has subsequently been a publication of a 26-week non-blinded randomised trial that compared subcutaneous liraglutide 1.2mg and 1.8mg daily with oral sitagliptin 100mg daily, all in addition to metformin, in 665 patients with type 2 diabetes and inadequate glycaemic control despite treatment with metformin for 3 months or longer. The results of this study show that liraglutide reduces HbA1c levels more than sitagliptin, but do not affect the conclusion of DTB’s review on liraglutide for type 2 diabetes].