J CHEONG1, K KAMESHWAR1, J COHEN4, S. HAMBLIN1, S COHNEY1, 2,3,
1Western Health 1, Footscray; 2University of Melbourne,2,Melbourne; 3Dept Epidemiology, Monash University,3, VIC; 4Cabrini Health Care,4,Malvern
Background: In diabetic patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD), treatment to lower blood glucose has been limited to insulin and sulphonylureas, with the inherent problems of weight gain and hypoglycaemia. GLP1 receptor agonists largely avoid hypoglycaemia and facilitate weight loss, but have also been unavailable for these patients.
Case report: Two obese patients with diabetes, both with creatinines over 350umol/l and receiving significant doses of insulin were commenced on Liraglutide with concomitant reduction in insulin . Patient one had a 7-year history of diabetes and at the time of review was taking 230 units of insulin with HbA1c 15%, and weight 205kg. Three months after commencing liraglutide, he was insulin free, taking gliclazide 80 mg b.d and Liraglutide 1.2mg daily. His HbA1c had fallen to 7% with weight loss of 20kg. He continued on this regimen when he began dialysis without ill-effect. Patient two had a 20 year history of diabetes and was being managed with an insulin pump (total of 60 units per day), with HbA1c 7.9% and initial weight 124kg. After 6 weeks of Liraglutide (titrated to 2.4mg) weight fell to 116kg, and insulin usage fell to 36 units per day . After 3 months, HbA1c fell to 6.5% whilst on 2.4mg Liraglutide. Patient 1 developed a sinus tachycardia. Patient 2 experienced mild intermittent nausea. There were no episodes of hypoglycaemia
Conclusions: In patients with advanced CKD & ESKD liraglutide may enable a reduction in insulin requirement, and facilitate weight loss with minimal risk of hypoglycaemia. Further clinical studies are warranted.