Since the landmark discovery of insulin by in 1921, advances in the treatment of type 1 diabetes have centered mainly on preparations of insulin with different rates of absorption from the subcutaneous tissue (region beneath the skin). These modifications led to a variety of insulin preparations. Some have prolonged bioavailability like Lantus, Levemir, or NPH. Others have more rapid absorption than human insulin, like Novolog, Humalog and others. Both facilitate diabetes management. Use of insulin pumps and continuous glucose monitoring systems contribute further to management of blood sugars.
With consistent efforts, some patients are able to maintain their HbA1c (A1c) (an estimate of the average blood sugar in last 3 months) at the goal of 7% or under. However, adequate blood sugar control in patients with type 1 diabetes still continues to be a major challenge. Even in patients with an A1c of less than 7%, blood sugars are erratic and have wide oscillations. This leads to frustration for the patient and the treating physician! Thus novel means are still being sought to improve blood sugar control in patients with type 1 diabetes.
In 2011, research conducted at SUNY Buffalo showed for the first time that a once-a-day injection of a drug containing a glucagon-like peptide-1 analog called Liraglutide (Victoza)) in addition to insulin resulted in the reduction of average fasting and weekly blood sugars. Furthermore, there was a reduction in blood sugar oscillations. Use of Victoza was also associated with a decrease in insulin requirements. There was no change in the frequency of low blood sugars, but A1c levels decreased by 0.5%. The fall in HbA1c occurred in spite of fact that the baseline A1c was 6.5%, implying that these patients were already well controlled. Additionally, there was a weight loss of almost 10 pounds over a period of 24 weeks.
With the use of Victoza our SUNY Buffalo team has also demonstrated similar benefits in poorly controlled and obese patients. These patients had Type 1 diabetes and an average weight of 212 pounds. This is extremely relevant, since most patients with type 1 diabetes are not well controlled, and over 50% of patients with type 1 diabetes in the United States are obese.
Our results have been exciting, but we still need to do further research. The Endocrinology Division of the University at Buffalo is conducting studies to assess the effects of Victoza (Liraglutide) in patients with type 1 diabetes. If you are interested in participating in this clinical trial please visit our website at www.ubdiabetes.com or call 716-626-7998 for more information.
About the Author
Nitesh Kuhadiya is an endocrinology fellow in the Division of Endocrinology and Metabolism, University at Buffalo. Dr. Kuhadiya is a member of the research team of Dr. Paresh Dandona that is conducting four randomized placebo controlled trials on the effect of Liraglutide in Type 1 diabetes.