GLP-1 Analogues-Liraglutide For Type 2 Diabetic: Systemetic Review

Objective To assess the efficacy and safety of GLP-1 analogues Liraglutide for Type 2 diabetic.Methods To search MEDLINE(1966 to 2008.12),EMBASE(1974 to 2008.12),The Cochrane library(Issue 4,2008),Current Controlled Trials,The National Research Register,CBM(1983 to 2008.12),CNKI(1994 to 2008.12) electronically.The search was concluded in December,2008.The quality of included randomized controlled trials(RCTs) was evaluated and meta-analysis was conducted by the Cochrane Collaboration's software RevMan 5.0.Result Six trials involving 2621 participants with T₂DM were included. There were 1835 participants in treatment group and 786 partieipants in control group.The longest duration of intervention was 52 weeks and the minimum was 12 weeks in trials.Meta-analysis indicated that for efficacy Liraglutide was more effective than Placebo in reducing hemoglobin A₁c,FPG,PPG, proinsulin/insulin,The effect sizes were[SMD=-1.36,95%CI(-1.93,-0.80)],[SMD=-0.77,95%CI(-0.97,-0.57)],[SMD=-1.14,95%CI(-1.7,-0.57)]; Liraglutide was more effective than OAD in promoting insulin secretion[SMD =0.32,95%CI(0.08,0.55)],reducing proinsulin/insulin[SMD=-0.14,95%CI (-0.26,-0.01)],and improving the quality of insulin secretion and was noninferior than OAD in reducing hemoglobin A1c,FPG and PPG.For side effects Liraglutide had a similar risk of hypoglycemia and gaining weight with placebo,but the rate of drop out because of other adverse events was significantly higher in Liraglutide group[Peto OR=1.80,95%CI (1.07,3.02)];Liraglutide reduced the risk of hypoglycemia[RR=0.27, 95%CI(0.21,0.35)],but the rate of drop out because of other adverse events was significantly higher in Liraglutide group than OAD[Peto OR=2.38,95%CI (1.49,3.81)].Adverse effects were reported in all of 6 studies which of the most were gastrointestinal reaction.And these events were mostly slightly and transient.It suggested that Liraglutide was safe.It was reported in the study that there were two partieipants withdrawned for pancreatitis,one(Liraglutide1.2mg) and another(Liraglutide1.8mg),who were hospitalized for 7 days and subsequently recovered.And it was reported in another study that two participants had pancreatitis receiving liraglutide and recovered after treatment. All but 1 trial had a more than 30-week duration;thus,long-term efficacy and safety could not be evaluated.Conclusions Liraglutide is effective in lowering hemoglobin A₁c,FFG,PPG,and promoting insulin secretion,and improving the quality of insulin secretion while not gaining weight.Furthermore,it lower the risk of hypoglycemia.Adverse reactions of its is relatively slighter.