An examination of switching from insulin to glucagon-like peptide-1 analogue liraglutide in hemodialysis patients with type 2 diabetes: A descriptive epidemiology study

Matsushita Ryuji, Taniguchi Shotaro, Matsuzaki Keiichi, Furumatsu Yoshiyuki, Yanagihara Yumiko, Harada Kazuko, Nakayama Koujin, Kato Kaori, Nakashima Tomonori, Nakamura Shuji, Nagatomo Masanao

doi:10.4009/jsdt.46.923

Background and objective：A number of established oral antidiabetic drugs are unsuitable for hemodialysis patients with type 2 diabetes. Some hemodialysis patients use insulin in their glucose management despite having sufficient endogenous insulin secretion. Liraglutide, a human glucagon-like peptide-1 analogue that is administered as a once-daily subcutaneous injection, induces glucose-dependent insulin secretion, which limits the risk of hypoglycemia. Liraglutide may be safe and effective treatment in hemodialysis patients. Switching from insulin to liraglutide in hemodialysis patients with type 2 diabetes may have some advantages, such as reducing hypoglycemia and the number of injections. However, little is known about the switching. We accumulated and analyzed the clinical information of hemodialysis patients with type 2 diabetes who underwent switching from insulin to liraglutide. Design：Descriptive epidemiology study. Participants and setting: Among 48 hemodialysis patients with type 2 diabetes at Heiwadai Hospital from September 2010 to April 2011, 10 patients who had fasting serum C-peptide immunoreactivity (s-CPR) ≥1.0 ng/mL and 2h-postprandial s-CPR≥4.0 ng/mL by meal tolerance test were included in this study. Exposure: Switching from insulin to liraglutide. Main outcome measure: Glycoalbumin (GA) value at three months after switching. Results: 3 out of 10 patients discontinued due to nausea and vomiting, and 2 patients due to hyperglycemia. In 5 patients who were able to continue liraglutide, GA levels were decreased from 21.8±3.3 at baseline to 19.6±1.9 at 3 months after switching, but this was not statistically significant. Conclusion: Switching from insulin to liraglutide is expected to be one of the useful strategies for hemodialysis patients with type 2 diabetes who have sufficient endogenous insulin secretion. When prescribing liraglutide, care should be taken for nausea and vomiting.

An examination of switching from insulin to glucagon-like peptide-1 analogue liraglutide in hemodialysis patients with type 2 diabetes: A descriptive epidemiology study

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