Liraglutide leads to better control of blood sugar after bariatric surgery: Gravitas trial

Adjunctive treatment with Liragalutide after bariatric surgery leads to a better control of blood sugar, finds a Lancet study.

The use of liraglutide, a glucagon-like peptide-1 analogue, as an adjunctive treatment in patients with persistent or recurrent type 2 diabetes (T2D) after bariatric surgery leads to better blood sugar control, finds a recent study published in the journal The Lancet Diabetes & Endocrinology.

Many patients with type 2 diabetes who undergo metabolic (bariatric) surgery for the treatment of obesity are not able to achieve sustained remission after the surgery. Liraglutide is known to improve blood sugar control and reduce weight in such patients.

"The number of bariatric operations done worldwide in 2016 was 609 897. Since 2013, sleeve gastrectomy procedures exceeded Roux-en-Y gastric bypasses in number. Currently, sleeve gastrectomy and Roux-en-Y gastric bypass remain the two most common bariatric procedures worldwide," Geltrude Mingrone, Diabetes and Nutritional Sciences, King's College London, London, UK, wrote in an accompanying editorial.

Alexander Dimitri Miras, Imperial College London and Imperial College Healthcare NHS Trust, London, UK, and colleagues conducted this study to assess the safety and efficacy of liraglutide 1·8 mg in patients with persistent or recurrent type 2 diabetes after metabolic surgery.

In the GRAVITAS trial, the researchers enrolled those adults from the hospitals in London, UK who had undergone Roux-en-Y gastric bypass or vertical sleeve gastrectomy and had persistent or recurrent T2D with HbA _1c levels higher than 48 mmol/mol (6·5%) at least one year after the surgery. The 80 patients were randomized (2:1) to receive either subcutaneous liraglutide 1·8 mg once daily (n=53) or placebo (n=27) via a computer-generated sequence. Both the groups were given a reduced-calorie diet, aiming for a 500 kcal per day deficit from baseline energy intake, and indulged in physical activity.

The primary outcome was the change in HbA _1c from baseline to the end of the study period at 26 weeks, assessed in patients who completed the trial.

Key findings of the study include:

• 71 (89%) participants completed the study and were included in the principal complete-cases analysis.


• In a multivariable linear analysis, liraglutide treatment was associated with a difference of −13·3 mmol/mol (−1·22%) in HbA _1c change from baseline to 26 weeks, compared with placebo.


• Type of surgery had no significant effect on the outcome. 24 (45%) of 53 patients assigned to liraglutide and 11 (41%) of 27 assigned to placebo reported adverse effects: these were mainly gastrointestinal and in line with previous experience with liraglutide.


• There was one death during the study in a patient assigned to the placebo group, which was considered unrelated to study treatment.

These findings support the use of adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery.

For further study related details log on to https://doi.org/10.1016/S2213-8587(19)30157-3