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Benefits of Liraglutide, Exercise and Low-Calorie Diet on Patient Outcomes
N Engl J Med; 2021 May 6;384(18):1719-1730. doi: 10.1056/NEJMoa2028198
This is a randomized controlled trial of 195 obese adults without diabetes. After an 8-week low-calorie diet, participants randomized for 1 year to: moderate-to-vigorous-intensity exercise program plus placebo (Exercise group); liraglutide (3.0 mg per day) plus usual activity (Liraglutide group); exercise plus liraglutide therapy (Combination group); or placebo plus usual activity (placebo group).
After the 8-week low-calorie diet, mean decrease in body weight of 13.1 kg.
At 1 year, all the active-treatment strategies had greater weight loss than placebo:
--Exercise group, -4.1 kg (95% [CI], -7.8 to -0.4; P = 0.03);
--Liraglutide group, -6.8 kg (95% CI, -10.4 to -3.1; P<0.001);
--Combination group, -9.5 kg (95% CI, -13.1 to -5.9; P<0.001).
Combination group decreased body-fat better than exercise group (3.9% vs -1.7%) and the liraglutide group (-1.9%). Only the combination group reduced A1c levels, insulin sensitivity, and cardiorespiratory fitness. Interestingly, the initial low-calorie diet had the greatest impact on body fat, A1c levels and overall perception of health compared to any of the later interventions.
A low-calorie diet had the greatest impact on patient outcomes; use of Liraglutide and exercise after initiating the diet best maintained those outcomes.
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Contributed by Frank J. Domino, MD, May 19, 2021