5MinuteConsult Journal Club

Adding Liraglutide to Metformin Lowers CV Disease

Reference

N Engl J Med. 2022 Sep 22;387(12):1075-1088. doi: 10.1056/NEJMoa2200436

Study Summary

Comparative effectiveness review over 5.0 years of 5047 participants to determine how insulin glargine U-100, glimepiride, liraglutide, and sitagliptin, when added to metformin for type 2 diabetes altered outcomes (hypertension, dyslipidemia, renal function, diabetic peripheral neuropathy, and cardiovascular events (major adverse cardiovascular events [MACE]), hospitalization for heart failure, or an aggregate outcome of any cardiovascular event), and death.

The only differences found for any cardiovascular disease were in the liraglutide group; HR= 0.7 (95% CI, 0.6 to 0.9).

Conclusions

For patients with Type 2 Diabetes, adding a GLP-1 agonist (liraglutide) lowers the risk of cardiovascular outcomes within 5 years.

Discussion

This is to me a landmark publication. The “next step” after metformin should be a GLP-1 agonist. I use this to encourage patients to being open to an injection once a week (and losing weight), and to insurers when the prior authorization is completed.

My advice is to bookmark this paper. Reference it in your prior auths. The page is turning for T2DM care, and some of our frustrations are lessening.

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Contributed by Frank J. Domino, October 12, 2022