In:
Diabetes, Obesity and Metabolism, Wiley, Vol. 19, No. 2 ( 2017-02), p. 239-247
Abstract:
Among patients with type 2 diabetes and albuminuria, cardiorenal morbidity and mortality are high despite multifactorial treatment. Short‐term reduction in albuminuria is considered suggestive of long‐term renoprotective effects. We evaluated the renal effects of the glucagon‐like peptide‐1 ( GLP ‐1) receptor agonist liraglutide on top of multifactorial care, including renin‐angiotensin‐system ( RAS )‐inhibition. Materials and methods Randomized, double‐blind, placebo‐controlled, cross‐over trial including patients with type 2 diabetes and persistent albuminuria (urinary albumin‐to‐creatinine ratio 〉 30 mg/g) and estimated glomerular filtration rate ( eGFR ) ≥30 mL /min/1.73 m 2 . Patients received liraglutide (1.8 mg/d) and matched placebo for 12 weeks in a random order. The primary endpoint was change in 24‐h urinary albumin excretion rate ( UAER ). Results A total of 32 patients were randomized and 27 completed the study. After placebo treatment, geometric mean ( IQR ) UAER was 199 (81‐531) mg/24‐h, mean ( SD ) measured GFR ( mGFR ) 75 (36) mL /min/1.73 m 2 , 24‐h blood pressure 145/80 (15/8) mm Hg and HbA1c 61 (11) mmol/mol. Liraglutide reduced HbA1c by 8 (95% CI : 5; 11) mmol/mol ( P 〈 .001) and weight by 1.8 (95% CI : 0.2; 3.4) kg ( P = .032) compared to placebo. Furthermore, liraglutide reduced UAER by 32 (95% CI : 7; 50)% ( P = .017) compared with placebo. The change in mGFR was −5 (95% CI : −11; 2) mL /min/1.73 m 2 ( P = .15), and change in 24‐h systolic blood pressure was −5 (95% CI : −10; 0) mm Hg ( P = .07). In multivariate regression models, change in UAER was associated with change in 24‐h systolic blood pressure ( P = .025) but not with change in HbA1c , weight or mGFR ( P ≥ .14), overall model R 2 = .39. Conclusions Our placebo‐controlled randomized trial suggests that liraglutide has renoprotective effects on top of multifactorial treatment, including RAS ‐inhibition, in patients with type 2 diabetes and albuminuria.
Type of Medium:
Online Resource
ISSN:
1462-8902
,
1463-1326
DOI:
10.1111/dom.2017.19.issue-2
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2004918-3
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