ADA 2019—RISE findings not so DiRECT about beta-cell recovery


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • In patients with early type 2 diabetes (T2D) or impaired glucose tolerance (IGT), active treatment that improves beta-cell function does not have lasting effects following drug withdrawal.
  • Findings of RISE (Restoring Insulin Secretion) trial vary from those of DiRECT, showing 2-year benefit of rapid weight loss to levels that are sustained for 2 years.

Why this matters

Key results

  • All active treatments (12 months) in the trial yielded HbA1c improvements, weight loss vs placebo.
  • Liraglutide+metformin produced greatest improvement.
  • Adherence to the regimens was >90% for all groups.
  • At 3 months following treatment withdrawal, beta-cell improvements had not persisted in any group.

Study design

  • 3-center, randomized, partially blinded trial involving 267 adults with IGT (197) or T2D (70). 
  • 4 treatment groups: metformin only for 12 months; 3 months insulin glargine followed by 9 months of metformin; 12 months of liraglutide+metformin; 12 months of placebo.
  • Outcome: beta-cell function at 15 months vs baseline.
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases; ADA; Novo Nordisk A/S and other industry; others.

Limitations

  • Target fasting glycemia had low achievement rate with glargine.
  • Fewer completers among liraglutide-metformin group.

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