Liraglutide in the treatment of Type 2 diabetes: clinical data and practical considerations for its use.

Liraglutide is the first once-daily human glucagon-like peptide-1 analog available for use in clinical practice. It has recently been approved by the EMA and the US FDA for treatment of Type 2 diabetes mellitus (T2DM). Initial approval is for use in combination with either metformin or a sulfonylurea, or in combination with metformin plus a sulfonylurea or thiazolidinedione. Liraglutide monotherapy is approved in the USA. Results from the Liraglutide Effect and Action in Diabetes (LEAD) clinical trials program indicate that liraglutide significantly lowers glycosylated hemoglobin (HbA1c) with a low risk of hypoglycemia. Liraglutide is also associated with significant and sustained weight loss, decreased systolic blood pressure, and improvements in other markers of cardiovascular risk. Liraglutide also shows strong potential to preserve ß-cell function. Maximum benefits may be achieved when liraglutide treatment is initiated early on in the course of T2DM.

The European EUCCLID pilot study on care and complications in an unselected sample of people with type 2 diabetes in primary care.

BACKGROUND: European studies on quality of diabetes care in an unselected primary care diabetes population are scarce. RESEARCH QUESTION: To test the feasibility of the set-up and logistics of a cross-sectional EUropean study on Care and Complications in patients with type 2 diabetes (T2DM) in Primary Care (EUCCLID) in 12 European countries. METHOD: One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality indicators, UKPDS-risk engine, psychological and general well-being. RESULTS: We included 103 participants from 22 GPs in 11 countries. Central data and laboratory samples were successfully collected. Of the participants 54% were female, mean age was 66 years and mean duration of diabetes was 9.6 years. Besides, 18% were using insulin, 31% had a history of cardiovascular disease, mean HbA1c was 7.1% (range 6.6-8.0), mean systolic blood pressure was 133.7 mmHg (range 126.1-144.4) and mean total cholesterol was 4.9 mmol/l (range 4.0-6.2). CONCLUSION: A European study on care and complications in a random selection of people with T2DM is feasible. There are large differences in indicators of metabolic control and wellbeing between countries.

The EUCCLID study: proposed European study on care and complications in people with type 2 diabetes in primary care.

AIM: The EUCCLID study aims to compare the quality of type 2 diabetes (DM2) care and the prevalence of complications in primary care DM2 patients in Europe. DESIGN: A cross-sectional survey consisting of three parallel studies: (1) study on actual clinical practice; (2) study on patient's perspective of diabetes care; (3) study on general practitioner's perspective of diabetes care. METHODS: Patients will be randomly selected from a list of all patients known to the participating GPs with DM2 for whom the GP is the main diabetes care provider. Exclusion criteria will include people with type 1 diabetes mellitus, diabetes of pregnancy, serious mental illness, unable to complete a questionnaire in national language or unable to give written informed consent. Approximately 12,000 patients will be included. Participants will have a detailed medical history and anthropometric measurements, blood and urine will be collected and questionnaires will be taken. Endpoints will include quality indicators of clinical DM2 care, prevalence of diabetic complications, knowledge, attitudes, barriers and behaviour affecting good control in DM2 patients, quality of life and patients' satisfaction with diabetes care. We will also determine primary care physician's attitudes, behaviour and perception of barriers to deliver effective diabetes care.