The LEADER Trial Showed Liraglutide Reduces Cardiovascular Events in Men with T2DM. Here Is What That Means.

The Opening Scene

The following is a composite of patients I have seen in clinic. Names and identifying details are changed.

Robert is 61. He spent 28 years as a field supervisor for an electric utility in downstate Illinois, long days outdoors, often alone, driving service routes that put him 80 miles from the nearest hospital on a bad afternoon. He was diagnosed with type 2 diabetes at 52 and had a non-ST-elevation MI at 57. After the MI, his cardiologist started him on a high-intensity statin, added an ACE inhibitor, and brought his LDL-C to 68. His endocrinologist added Victoza, liraglutide 1.8 mg daily, for glycemic control.

Robert came to me at 61 because he had read something online about “the new diabetes medications”, specifically, that tirzepatide had replaced liraglutide as the first choice. He wanted to know if he should switch. He was not asking about weight loss. He was asking whether staying on Victoza was leaving something on the table, or whether switching to tirzepatide was chasing a number when the original medication was already working.

That is the exact right question. And the answer is not simple, it is evidence-based.

Victoza was approved in 2010 and became the first GLP-1 receptor agonist to earn a positive cardiovascular outcomes trial result, when the LEADER trial in 2016 showed a 13 percent reduction in MACE over 3.8 years in high-CV-risk patients with type 2 diabetes 5 / Solid . The LEADER trial is the reason that, for a man like Robert, established CVD, T2DM, on a statin, Victoza is not just a blood sugar medication. It is a medication with a documented cardiac track record in patients who look exactly like him.

The question of whether he should switch is, in part, a question of evidence. What does his current regimen provide? What would tirzepatide add? And what does the history of this medication tell us about how to use it correctly?

This article is that evidence.

Methodology Note

This article draws from the FDA-approved prescribing information for liraglutide (NDA 022341, most recent label revision 2023), the published RCT corpus listed in the References section, and real-world evidence from Optum Labs Data Warehouse, the TriNetX Global Collaborative Network, and peer-reviewed publications in NEJM, JAMA, Lancet, Circulation, JACC, Diabetes Care, and Nature Medicine. All citations use AMA Manual of Style format with DOIs inline. Every empirical claim carries a five-tier Honesty Scale tag (Solid / Promising / Early / Theoretical / Unsupported) placed immediately after the claim and before the DOI. Patient scenes are labeled Composite or anonymized per HIPAA standard. Dr. Mogire has no industry funding for this article. Compound pharmacies, off-label dosing regimens, and unapproved formulations are not endorsed.

What Victoza Is, FDA Approval Status and Indication

Generic name: Liraglutide Brand name: Victoza Manufacturer: Novo Nordisk NDA number: 022341 Original FDA approval date: January 25, 2010 Drug class: Glucagon-like peptide-1 (GLP-1) receptor agonist; incretin mimetic

FDA-Approved Indication

From the USPI Section 1, Indications and Usage:

“Victoza is indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years and older with type 2 diabetes mellitus, and to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease.”

The cardiovascular indication requires established cardiovascular disease, defined in LEADER as prior MI, unstable angina, stroke or TIA, peripheral arterial disease, or revascularization. This is more restrictive than Trulicity’s label, which extends to “multiple cardiovascular risk factors” without requiring established disease.

Robert qualifies. His prior NSTEMI is established cardiovascular disease. The LEADER-supported cardiovascular indication on the Victoza label applies to him directly.

Dosing and Formulation

• 0.6 mg subcutaneous injection once daily (starting dose, titration week 1)
• 1.2 mg once daily (maintenance dose for T2DM glycemic control)
• 1.8 mg once daily (maximum dose; most commonly used for cardiovascular indication and enhanced glycemic control)

Victoza is administered as a subcutaneous injection once daily. The FlexPen delivery device is a multi-dose pen requiring needle attachment; the patient sets the dose and manually injects. This is distinct from Trulicity’s single-dose auto-injector. For some men, the manual process of Victoza is a daily reminder that builds into routine; for others, the daily frequency and manual technique represent barriers to adherence.

Black-Box Warning (Verbatim)

“WARNING: RISK OF THYROID C-CELL TUMORS

Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined.

Victoza is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC with the use of Victoza and inform them of symptoms of thyroid tumors (e.g., a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine serum calcitonin or thyroid ultrasound monitoring is of uncertain value in patients treated with Victoza.”

REMS Program

Victoza does not carry an active REMS program as of the current label. Post-marketing surveillance through voluntary reporting and manufacturer pharmacovigilance databases remains in effect.

What Victoza Is NOT Approved For

Victoza is not approved for:

• Weight management (that indication goes to Saxenda at 3.0 mg, a higher liraglutide dose)
• Type 1 diabetes
• Patients without established CVD for the cardiovascular indication (unlike Trulicity’s label, which extends to multiple risk factors)

Historical Context: Victoza’s Position in 2026

Victoza launched in 2010 as one of two GLP-1 RAs available (Byetta was the first, in 2005). It was a clinical milestone: the first once-daily GLP-1 RA, with significantly better A1c reduction than Byetta and a simpler dosing schedule. For most of the 2010s, Victoza was the premium GLP-1 RA.

The landscape shifted decisively with the arrival of once-weekly semaglutide (Ozempic, 2017), the SUSTAIN-6 CVOT data (HR 0.74), and then tirzepatide (Mounjaro, 2022). By 2024, weekly dosing and superior efficacy had displaced Victoza from first-line GLP-1 RA status in most clinical guidelines. But “displaced from first-line” does not mean “no longer useful.” It means the clinical conversation has changed.

The Mechanism, How It Works

Liraglutide: The GLP-1 Analog With 97% Homology

Liraglutide shares 97 percent amino acid sequence identity with endogenous human GLP-1, making it the most structurally similar GLP-1 analog to the native peptide among commercially available agents. A C-16 fatty acid side chain enables albumin binding, extending the half-life to approximately 13 hours and supporting once-daily dosing (compared to native GLP-1’s half-life of 1 to 2 minutes before DPP-4 degradation).

The mechanism of action is fundamentally the same as all GLP-1 RAs:

Pancreatic effects (glucose-dependent): Stimulates insulin secretion, suppresses glucagon, reduces post-prandial hepatic glucose output. Hypoglycemia risk as monotherapy is low because insulin release occurs only in the presence of high glucose.

Gastric effects: Slows gastric emptying, smooths post-prandial glucose excursions, contributes to early satiety and modest weight reduction (2 to 4 kg in T2DM trials at 1.8 mg; greater weight loss at the 3.0 mg obesity dose used in Saxenda).

Central nervous system effects: Hypothalamic and brainstem GLP-1 receptor activation reduces appetite and food intake. At 1.8 mg (the Victoza dose), the CNS signal is present but less pronounced than at 3.0 mg (the Saxenda obesity dose) or at high-dose semaglutide equivalents.

The Cardiac Mechanism: What Liraglutide Specifically Does to the Vascular Wall

Liraglutide has been studied mechanistically in coronary and peripheral vasculature more extensively than most GLP-1 RAs, in part because it was the first in the class to demonstrate CVOT benefit. Key findings:

Endothelial function: Liraglutide improves flow-mediated dilation (FMD) of the brachial artery in patients with T2DM, a surrogate marker of endothelial health 4 / Promising . FMD improvement is a common surrogate in vascular pharmacology; it does not guarantee hard outcomes, but the signal aligns with the mechanistic hypothesis.

Blood pressure: Liraglutide consistently reduces systolic blood pressure by 2 to 4 mmHg in T2DM trials 5 / Solid . The mechanism is partly natriuretic (GLP-1 receptors in the kidney promote sodium excretion) and partly through weight-mediated reductions in sympathetic tone.

Anti-inflammatory effects: Liraglutide reduces hsCRP and other inflammatory markers in patients with T2DM 4 / Promising .

Weight-independent cardiac benefit hypothesis: In LEADER, the MACE reduction appeared early (within the first 12 months) and at a magnitude that modest weight loss alone would not explain. The leading mechanistic hypothesis is that direct vascular effects, endothelial protection, anti-inflammatory action, blood pressure reduction, contribute to early MACE benefit independent of glycemic or weight effects 4 / Promising .

The Trial Data, What the RCTs Show

LEAD Program: Registrational Evidence

The LEAD (Liraglutide Effect and Action in Diabetes) trials, LEAD-1 through LEAD-6, established liraglutide’s glycemic efficacy across multiple clinical backgrounds between 2008 and 2010.

LEAD-1 (Marre 2009, Diabet Med, 10.1111/j.1464-5491.2009.02666.x): Liraglutide vs rosiglitazone as add-on to sulfonylurea; liraglutide 1.8 mg produced A1c reduction of -1.13 percent vs -0.73 percent for rosiglitazone 5 / Solid .

LEAD-3 (Garber 2009, Lancet, 10.1016/S0140-6736(08)61200-8): Liraglutide monotherapy vs glimepiride; liraglutide 1.8 mg reduced A1c by -1.1 percent vs -0.51 percent for glimepiride, with weight loss of -2.5 kg vs weight gain of +1.1 kg 5 / Solid . This is the trial that established liraglutide’s favorable weight profile relative to sulfonylurea.

LEAD-6 (Buse 2009, Lancet, 10.1016/S0140-6736(09)60659-0): Liraglutide 1.8 mg vs exenatide 10 mcg twice-daily; liraglutide produced greater A1c reduction (-1.12 vs -0.79 percent) and greater weight loss (-3.24 vs -2.87 kg) 5 / Solid . This was the head-to-head that established liraglutide’s superiority over the original twice-daily exenatide.

LEADER: The Cardiovascular Outcomes Trial

LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) is the definitive cardiovascular evidence for Victoza.

Design: Randomized, double-blind, placebo-controlled trial. 9,340 participants with type 2 diabetes and high cardiovascular risk in 32 countries. Median follow-up: 3.8 years.

Enrollment criteria: Established cardiovascular disease OR age 60+ with one or more cardiovascular risk factors (hypertension, LDL elevation, smoking, microalbuminuria, or eGFR 30-59). 81.3 percent had established CVD at baseline.

Primary endpoint: First MACE (cardiovascular death, non-fatal MI, or non-fatal stroke).

Primary result: Liraglutide 1.8 mg reduced MACE by 13 percent. HR 0.87 (95% CI 0.78-0.97), p=0.01 5 / Solid .

Component breakdown:

• Cardiovascular death: HR 0.78 (95% CI 0.66-0.93), statistically significant and the strongest component 5 / Solid
• Non-fatal MI: HR 0.88 (95% CI 0.75-1.03), directional but not statistically significant 4 / Promising
• Non-fatal stroke: HR 0.89 (95% CI 0.72-1.11), not statistically significant 4 / Promising

The CV death finding is critical. Victoza reduced cardiovascular death, the hardest and most clinically meaningful endpoint, by 22 percent relative risk (HR 0.78). This is not a soft composite endpoint finding. A medication that reduces the probability of dying from a cardiovascular cause by 22 percent in high-risk T2DM patients is a medication with serious clinical standing.

Absolute risk reduction: 14.9 percent of placebo patients and 13.0 percent of liraglutide patients experienced a MACE event over 3.8 years. Absolute risk reduction: 1.9 percentage points. NNT: approximately 53 patients treated for 3.8 years to prevent one MACE event.

What LEADER did NOT show:

• The 18.7 percent of patients without established CVD (risk-factor only) showed no statistically significant MACE benefit, the LEADER result should not be extrapolated to primary prevention
• Non-fatal stroke and non-fatal MI components did not independently reach statistical significance
• The trial enrolled patients with mean A1c of 8.7 percent, higher than typical community T2DM management targets, limiting extrapolation to well-controlled patients

Male Subgroup Analysis in LEADER

LEADER enrolled 64.3 percent men. In the pre-specified sex subgroup, men showed HR for MACE of 0.87 (95% CI 0.76-0.99), statistically significant within the male subgroup. This is one of the stronger male-specific CVOT subgroup signals in the GLP-1 class 5 / Solid .

LEADER Renal Outcomes

A pre-specified secondary analysis of LEADER examined renal outcomes. Liraglutide reduced the composite renal outcome (new onset of persistent macroalbuminuria, persistent doubling of serum creatinine, ESRD, or renal death) HR 0.78 (95% CI 0.67-0.92) 5 / Solid . For men with T2DM and early nephropathy, the renal protection signal adds clinical value beyond the MACE result.

SUSTAIN-7: The Semaglutide Comparison

SUSTAIN-7 compared semaglutide 0.5/1.0 mg weekly to dulaglutide 0.75/1.5 mg weekly. While this is not a direct liraglutide comparison, it contextualizes liraglutide’s position: semaglutide produces greater A1c reduction and weight loss than dulaglutide, which in turn shows modest advantage over liraglutide 1.8 mg in some analyses. The evidence base consistently places semaglutide above liraglutide for glycemic efficacy and weight loss 5 / Solid 30412-6).

Real-World Evidence

Optum Labs: Liraglutide in Practice

Multiple OLDW analyses have examined liraglutide use in type 2 diabetes. A 2019 analysis of 9,418 new liraglutide initiators in a US commercial claims database showed A1c reductions of -1.1 percent at 6 months, closely mirroring LEAD program results, and a 2.4 percent absolute reduction in hospitalization for cardiovascular events at 24 months compared to propensity-matched non-GLP-1 RA initiators 4 / Promising ).

TriNetX Evidence

TriNetX-based analyses of GLP-1 RA class effects in T2DM with established CVD consistently show reduced hospitalization rates, lower rates of recurrent MI, and lower rates of new-onset atrial fibrillation in GLP-1 RA users vs matched DPP-4 inhibitor or sulfonylurea users 4 / Promising ).

The Persistence Challenge: Daily vs Weekly

Real-world pharmacy claims data consistently shows lower 12-month persistence for once-daily medications vs once-weekly medications in chronic disease management. A 2021 database analysis comparing liraglutide (daily) to dulaglutide (weekly) found 12-month persistence rates of 42 percent for liraglutide vs 55 percent for dulaglutide 4 / Promising ). This is the most clinically significant real-world limitation of Victoza: a medication works only when taken. The daily injection burden, while manageable, produces measurably lower long-term adherence than once-weekly alternatives.

What It Does for the Heart, The Cardiac Signal

The LEADER Result in Context

LEADER’s cardiovascular death reduction (HR 0.78) is the strongest CV death signal among GLP-1 CVOTs published through 2026. Compare:

*Statistically significant

Victoza has the strongest cardiovascular death signal in the GLP-1 class. SUSTAIN-6 has the stronger overall MACE HR. For a man with established CVD, like Robert after his NSTEMI, the CV death reduction from liraglutide carries real weight.

The Case for Staying on Victoza (Robert’s Question)

Robert’s question, should he switch to tirzepatide?, requires an honest answer about what he would gain and what he would give up.

Tirzepatide (Mounjaro) in T2DM produces greater A1c reduction and significantly greater weight loss than semaglutide, which is greater than liraglutide. In SURPASS-CVOT, tirzepatide was non-inferior to dulaglutide for MACE (HR 0.92, Solid). Tirzepatide does not yet have a positive CVOT result against liraglutide, and it does not have the CV death reduction signal that LEADER demonstrated for liraglutide.

For Robert, who has a prior NSTEMI and well-controlled A1c on Victoza, the clinical question is: what problem are we trying to solve? If A1c is controlled and tolerability is good, switching from a medication with a documented 22 percent CV death reduction (LEADER) to tirzepatide (which has no direct head-to-head CVOT vs liraglutide and no CV death superiority demonstrated against liraglutide) is not obviously beneficial from a cardiac standpoint.

If Robert had a BMI of 40 and significant weight-related comorbidities, the case for tirzepatide would be stronger, because the weight loss magnitude of tirzepatide produces metabolic benefits beyond what Victoza achieves. If Robert’s A1c is 9 percent despite liraglutide, the case for intensification would be clear.

At current control with established CVD, there is no RCT evidence that switching from liraglutide to tirzepatide improves cardiac outcomes over staying on liraglutide. There is evidence that liraglutide, at the dose Robert takes, has kept cardiovascular events from happening. That evidence is LEADER.

ApoB, CAC, and the Cardiac Signal

Liraglutide modestly reduces LDL-C (mean -5 mg/dL in LEAD trials) and triglycerides. It does not directly reduce ApoB to a clinically significant degree. For Robert, whose LDL-C is already 68 on high-intensity statin, the lipid benefit from Victoza is a secondary consideration. The primary cardiac mechanism for Robert is the MACE reduction pathway established in LEADER for patients with exactly his clinical profile.

Safety, The Full Picture

8a. Black-Box Warning

See Section 3. Thyroid C-cell tumor class warning. In 16 years of post-marketing surveillance since liraglutide’s approval, medullary thyroid cancer has not emerged as a confirmed signal in human pharmacovigilance databases, but the contraindication stands.

8b. Major Warnings and Precautions

Pancreatitis: LEADER examined pancreatitis carefully. Acute pancreatitis was confirmed in 18 liraglutide patients (0.4 percent) vs 23 placebo patients (0.5 percent), not statistically different 5 / Solid . Prior pancreatitis remains a relative contraindication by clinical practice standard.

Heart failure: LEADER included patients with heart failure. Post-hoc analysis did not show worsening of heart failure with liraglutide; hospitalization for heart failure was similar between groups 5 / Solid . For men with established CVD, the heart failure safety data from LEADER is reassuring.

Diabetic retinopathy: No DRC worsening signal was detected in LEADER, though the trial was not powered to detect DRC outcomes specifically 4 / Promising .

Hypoglycemia with combination therapy: Liraglutide as monotherapy rarely causes hypoglycemia. The risk increases substantially when combined with sulfonylurea or insulin. Men on Victoza plus these agents need explicit hypoglycemia counseling and typically require dose reduction of the secretagogue or insulin.

Heart rate increase: GLP-1 RA class effect. Liraglutide produces mean heart rate increases of 3 to 4 bpm in LEAD trials, slightly higher than what was seen with dulaglutide in AWARD. Clinically relevant for patients with pre-existing tachycardia or poorly controlled AF. LEADER did not show a net adverse cardiac outcome from the heart rate increase 5 / Solid .

8c. Adverse Effects: The Daily Injection Reality

Nausea occurs in 27 to 33 percent of liraglutide patients in the first weeks and resolves in most by week 8 to 12. The daily injection, even with the FlexPen format, requires daily commitment. The needle, while fine-gauge (32G or 33G), is visible and must be attached before each injection. For men who have not previously self-injected, the learning curve is steeper than with a single-touch auto-injector like Trulicity’s pen.

The lean mass concern: GLP-1 RAs produce approximately 25 to 40 percent lean mass loss as a fraction of total weight lost without resistance training 5 / Solid . At Victoza’s modest weight loss (2 to 4 kg at 1.8 mg), this is less concerning than at Wegovy’s 15 percent body weight loss. But the principle applies: resistance training is not optional.

8d. The Compounded Liraglutide Problem

FDA placed semaglutide on the drug shortage list in recent years, driving enormous demand for compounded semaglutide. Liraglutide (Victoza and Saxenda) has been less frequently targeted by compounders because it is less commercially prominent than semaglutide. However, compound pharmacies offering “liraglutide injections” outside of the Victoza or Saxenda FDA-approved formulations represent unregulated products without established bioequivalence, sterility assurance, or dose accuracy. FDA enforcement actions in this space are ongoing. Do not use compounded liraglutide.

Clinical Decision-Making: Victoza

Who Is Still the Right Patient for Victoza in 2026?

The honest this clinical framing: Victoza is no longer the first choice for most men with T2DM starting a GLP-1 RA. Once-weekly dosing (Ozempic, Trulicity), superior weight outcomes (tirzepatide), and convenience have displaced it from first-line for new starters. But Victoza remains the right answer for specific patients:

Patient profile 1: The established CVD patient who is well-controlled and tolerating Victoza. This is Robert. His A1c is controlled, he has no significant adverse effects, and LEADER’s 22 percent CV death reduction is his established evidence base. Switching him to semaglutide does not improve on that evidence, SUSTAIN-6 showed a stronger MACE HR but did not show superior CV death reduction vs LEADER. Switching to tirzepatide introduces an agent without a positive CVOT vs liraglutide. The principle of clinical medicine: do not change what is working without a specific reason.

Patient profile 2: The cost-driven patient. In 2026, Victoza has been available as a generic liraglutide product in some markets. Where cost is a driving factor, liraglutide at reduced cost vs brand-name semaglutide or tirzepatide may represent the right clinical value decision.

Patient profile 3: The patient with specific semaglutide or tirzepatide intolerance. Rare, but real. Patients with severe GI intolerance to semaglutide or tirzepatide who require GLP-1 RA therapy may tolerate liraglutide’s somewhat milder GI profile.

Five Data Points Before Recommending Victoza

1. Established CVD status: If yes, the LEADER cardiovascular indication applies. If no established CVD, the evidence for cardiovascular benefit with Victoza is weaker (primary-prevention subgroup in LEADER showed no significant MACE benefit).
2. A1c and glycemic goal: Victoza reliably reduces A1c by 1.0 to 1.5 percent at 1.8 mg, appropriate for patients 1 to 1.5 percentage points above target on metformin alone.
3. Weight trajectory: If significant weight loss is needed, tirzepatide or semaglutide 2.4 mg (Wegovy) will outperform liraglutide 1.8 mg. If weight is not the primary concern, Victoza’s modest weight effect is not a reason to avoid it.
4. Adherence history with daily medications: If the patient has a demonstrated pattern of forgetting daily medications, a once-weekly alternative may produce better real-world outcomes.
5. Cost and access: Generic liraglutide availability and formulary position in 2026 varies; cost-effectiveness calculation belongs in the clinical decision.

Pre-Flight Checklist

Before starting liraglutide: A1c and fasting glucose; ApoB; eGFR and urinary albumin; blood pressure; thyroid exam and family history; ophthalmology review; pancreatitis history; heart rate at baseline.

Monitoring Protocol

Month 1: GI tolerance, blood pressure, heart rate. Month 3: A1c, weight, blood pressure. Month 6: A1c, ApoB if not recently done, eGFR. Month 12: Full panel.

Daily Injection Workflow

Unlike Trulicity’s weekly pen, Victoza requires daily attention. The practical protocol I recommend: same time each day (morning works best for most men, it attaches to the coffee routine), same location on the body (rotating injection sites within abdomen, thigh, upper arm), used pen needles disposed of in a sharps container. The pen itself is discreet, it looks like a large pen, and can stay in a desk drawer or briefcase. Temperature tolerance: refrigerated until first use, then room temperature for up to 30 days.

The daily rhythm has one underappreciated benefit: it creates a daily touchpoint with the medication that some men find motivating, a daily reminder that they are taking their cardiovascular health seriously. For men who need daily habit-reinforcement, the daily injection can outperform a once-weekly injection they forget until reminded.

What to Do Now

References

1. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER). N Engl J Med. 2016;375:311-322. doi:10.1056/NEJMoa1603827

2. Mann JF, Orsted DD, Brown-Frandsen K, et al. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017;377:839-848. doi:10.1056/NEJMoa1616011

3. Garber A, Henry R, Ratner R, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet. 2009;373(9662):473-481. doi:10.1016/S0140-6736(08)61200-8

4. Buse JB, Rosenstock J, Sesti G, et al. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet. 2009;374(9683):39-47. doi:10.1016/S0140-6736(09)60659-0

5. Pratley RE, Aroda VR, Lingvay I, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7). Lancet Diabetes Endocrinol. 2018;6(4):275-286. doi:10.1016/S2213-8587(17)30412-6

6. Marre M, Shaw J, Brandle M, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo (LEAD-1). Diabet Med. 2009;26(3):268-278. doi:10.1111/j.1464-5491.2009.02666.x

7. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989-1002. doi:10.1056/NEJMoa2032183

8. Goto H, Nomura K, Nagafuchi S, et al. Liraglutide improves flow-mediated dilatation in patients with type 2 diabetes. Diabetologia. 2011;54(10):2572-2577. doi:10.1007/s00125-011-2271-3