Schmidt Signe et al. presented secondary outcome analyses focusing on changes in body composition and dimensions, and evaluated changes in food intake to identify potential dietary drivers of the liraglutide-associated weight loss.

The study has an attractive study design; the author found that 26 weeks of liraglutide treatment resulted in loss of both fat and lean body mass; that liraglutide treatment led to a diminished intake of added sugars.

Several issues should be addressed before the paper is suitable for publication:

1. The results related to reduction in lean mass -2.5 kg (-3.2;-1.7, p<0.001) in lariglutide treated participants worries. A reduction in lean body mass could negatively affect health.

2. Authors suggest that the patients had already made attempts to lose weight through dietary restrictions. There were not any evidences for that. In practice we know that patients with type 1 diabetes don’t really try to restrict eating habits.

I sincerely doubt that people with type 1 diabetes are trying to lose weight with dietary restrictions. The patients are permanently taking insulin, which makes it impossible to restrict their food intake. Moreovere, insulin dose is slowly increasing time by time.

1. What gender were the 44 patients included in the study?

2. How many patients (in %) were not tolerated on liraglutide 1.8 mg per day?

3. In Conclusion has to be contraindication to liraglutide as gastroparesis; inflammatory bowel disease; renal dysfunction (eGFR < 60 ml/min/1.73m2); history of pancreatitis, cancer

4. According to Table 1 – Insulin pump treatment duration in placebo group (5-9 years) was more longer than in liraglutide group (3-7 years) – patients with type 1 diabetes in placebo group were more decompensated than in patients the main group. The compared groups were not equivalent between them.

5. In Table 1 P-value of BMI changes in placebo group presented as <0.001. According to the change it is not correct.

6. In Table 1 the change of HbA1c in placebo group (-0; 5) is not correct, because 0 has not a value.

7. Total daily carbohydrate intake (grams) in liraglutide group changed substantially (-6) in compare with placebo (+13.9) (Table 1), albeit not-significantly. Total daily basal insulin dose (U) also not-significantly changed in the compared groups. How can be sure that the results are related with liraglutide, but not with decrease in carbohydrate intake?