Liraglutide is a once-daily subcutaneous injection for managing overweight and obesity is new guidance from NICE, published in December 2020, advising that liraglutide can be used in the management of people who are overweight or obese and who also have prediabetes. It will be prescribed in tier 3 services, but I suspect that we will be involved in shared care agreements and that we will have patients asking to be referred onwards for this treatment.
When can liraglutide be used?
It can be used in adults alongside a reduced-calorie diet and physical activity programme IF:
- they have a BMI of at least 35 (or 32.5 if in a minority ethnic group if at higher risk of the effects of obesity) AND
- they have prediabetes AND
- they have a high risk of cardiovascular disease (at least one of a total cholesterol over 5 mmol/L, systolic BP over 140 or a low HDL level) AND
- it is prescribed by a specialist in a tier 3 weight service.
Where does this fit into current guidance?
At the moment options for weight loss other than diet and activity include orlistat and bariatric surgery. Only 0.1% of those suitable for bariatric surgery actually have it. Many patients will have tried orlistat before reaching tier 3 services. It is thought that liraglutide will be used if orlistat or bariatric surgery isn’t suitable or if the patient doesn’t wish to have them.
What are the benefits of liraglutide?
- Liraglutide gives a statistically significant weight loss benefit compared to placebo. After 3 years, there was a 6.14% weight loss in the liraglutide group vs 1.89% in the placebo group.
- Fewer people converted to type 2 diabetes whilst on it.
- More people converted from prediabetic to normoglycaemic on it.
- Liraglutide hasn’t been shown to reduce cardiovascular disease, but it is thought that it may because of its impact on prediabetes and weight loss.