Impact of the Glucagon Assay When Assessing the Effect of Chronic Liraglutide Therapy on Glucagon Secretion

• Published in: The journal of clinical endocrinology and metabolism 2017-08, Vol.102 (8), p.2729-2733
• Main Authors: Kramer, Caroline K, Zinman, Bernard, Choi, Haysook, Connelly, Philip W, Retnakaran, Ravi
• Format: Article
• Language: English
• Subjects: Antidiabetics; Assaying; Diabetes mellitus; Diabetes Mellitus, Type 2 - drug therapy; Double-Blind Method; Enzyme-Linked Immunosorbent Assay - methods; Fasting; GLP-1 receptor agonists; Glucagon; Glucagon - analysis; Glucagon - secretion; Glucagon-like peptide 1; Glucose; Glucose tolerance; Glucose Tolerance Test; Humans; Hypoglycemic Agents - therapeutic use; Liraglutide - therapeutic use; R&D; Randomized Controlled Trials as Topic; Research & development; Secretion
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2017-00928

Abstract Context Glucagon-like peptide-1 agonists acutely lower serum glucagon. However, in the Liraglutide and β-Cell Repair (LIBRA) Trial, 48-week treatment with liraglutide yielded lower/unchanged fasting glucagon but, surprisingly, enhanced postchallenge glucagonemia [measured by R&D Systems (Minneapolis, MN) assay]. Objective Because differences between glucagon assays potentially could explain these unexpected findings, we have remeasured glucagon in all 1222 samples from this trial using the highly-sensitive/specific Mercodia assay to compare the findings between assays. Design/Setting/Participants/Intervention In LIBRA, 51 patients with type 2 diabetes of 2.6 ± 1.9 years duration were randomized to daily subcutaneous liraglutide or placebo injection and followed for 48 weeks, with serial oral glucose tolerance test (OGTT) every 12 weeks (with liraglutide/placebo last administered ∼24 hours earlier). Outcome Serum glucagon was measured every 30 minutes on each OGTT, enabling determination of the area under the glucagon curve (AUCglucagon). Results With the Mercodia assay, fasting glucagon was higher in the liraglutide arm than placebo at 12 weeks (P = 0.01), with no between-group differences at 24, 36, and 48 weeks. There was no difference in AUCglucagon between the groups at any visit. Mercodia and R&D Systems glucagon measurements correlated at postchallenge time points but not at fasting. Conclusion The Mercodia assay did not replicate the R&D Systems glucagon findings. Although neither assay demonstrated lower postchallenge glucagonemia with chronic liraglutide last administered ∼24 hours earlier, the differential response reported by these assays precludes definitive conclusion and highlights the critical role of assay selection when measuring glucagon in clinical studies. The Mercodia and R&D Systems assays do not concur in evaluation of the impact of chronic liraglutide therapy on glucagon secretion, highlighting the critical role of glucagon assay differences.