Guidelines for the management of type 2 diabetes mellitus from the UK National Institute for Health and Clinical Excellence and the joint American Diabetes Association/European Association for the Study of Diabetes identify a role for glucagon-like peptide 1 (GLP-1) agonists as second- or third-line treatments. In the LEAD-2 trial the GLP-1 agonist liraglutide was similar to glimepiride for glycaemic control in patients receiving background metformin. Liraglutide was generally well tolerated, with a low incidence of hypoglycaemia, and it significantly reduced body weight and systolic blood pressure compared with glimepiride. These results suggest that addition of liraglutide may help to improve glycaemic control and reduce body weight and systolic blood pressure in patients with type 2 diabetes who have unsatisfactory control with metformin. Patients who are particularly obese or for whom hypoglycaemia is problematic may be especially suitable for this agent. The future place of liraglutide in guidelines will depend on further data regarding efficacy, tolerability and long-term benefits.
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