GLP-1 Receptor Agonists Assist in Overcoming Clinical Inertia in Type 2 Diabetes
Intensifiers were more likely to have an endocrinologist as the prescribing physician, hypertension, higher baseline HbA1c, obesity, and higher BMI.
Clinical inertia affecting patients with type 2 diabetes (T2D) taking basal insulin may be overcome by adding glucagon-like peptide-1 (GLP-1) receptor agonists, according to research published in Endocrine Practice.
This retrospective, observational study analyzed data from the Practice Fusion ambulatory electronic health record platform, which includes more than 18 million patients. The study looked at patients with T2D and glycated hemoglobin (HbA1c) levels above 7.0% (53 mmol/mol) while on basal insulin treatment. Of the 14,653 patients identified, 2,121 (14.5%) who intensified treatment with injectables like rapid-acting insulin or a GLP-1 receptor agonist were categorized as intensifiers, and 12,532 (85.5%) who modified treatment by adding an oral antidiabetes drug or altering basal insulin dose were categorized as non-intensifiers.
The study found that all groups, those with intensified therapies and those without, saw a decrease in HbA1c levels. Patients who tried new injectable therapies, including GLP-1 receptor agonists showed slightly better decreases in HbA1c. The researchers said, "After adjusting for differences in baseline characteristics between the subgroups, intensification with a GLP-1[ receptor agonist] led to a greater HbA1c reduction than in the [rapid-acting insulin] and other injectables subgroups, although the adjusted difference in reduction was not significant.”
Those on the GLP-1 receptor agonist therapies also saw a reduction in body weight, while those on other therapies saw a slight increase in body weight.
The study researchers conclude "adding a GLP-1[ receptor agonist] to basal insulin therapy in patients with T2D was as effective in terms of glycemic control as adding an [rapid-acting insulin] or other injectables. Furthermore, intensification with a GLP-1[ receptor agonist] was associated with a reduction in hypoglycemia events, albeit non-significantly, compared with the other subgroups and was the only option of all four groups that produced a reduction in mean body weight. These characteristics, when combined with its relatively easy use, support intensification with a GLP-1[ receptor agonist] in patients with uncontrolled T2D on a basal insulin regimen; this may be an effective strategy to reduce the problem of clinical inertia in a real-world setting."
This study was supported by Sanofi. Please refer to reference for a complete list of authors' disclosures.
Kallenbach L, Shui AM, Cheng WY, et al. Predictors and clinical outcomes of treatment intensification in patients with type 2 diabetes uncontrolled on basal insulin in a real-world setting [published online July 5, 2018]. Endocr Pract. doi: 10.4158/EP-2017-0261