Addition of or switch to insulin therapy in people treated with glucagon-like peptide-1 receptor agonists : A real-world study in 66 583 patients
© 2016 John Wiley & Sons Ltd..
BACKGROUND: Real world outcomes of addition or switch to insulin therapy in type 2 diabetes (T2DM) patients on glucagon-like paptide-1 receptor agonist (GLP-1RA) with inadequately controlled hyperglycaemia, are not known.
MATERIALS AND METHODS: Patients with T2DM (n = 66 583) with a minimum of 6 months of GLP-1RA treatment and without previous insulin treatment were selected. Those who added insulin (n = 39 599) or switched to insulin after GLP-1RA cessation (n = 4706) were identified. Adjusted changes in glycated haemoglobin (HbA1c), weight, systolic blood pressure (SBP), and LDL cholesterol were estimated over 24 months follow-up.
RESULTS: Among those who continued with GLP-1RA treatment without adding or switching to insulin, the highest adjusted mean HbA1c change was achieved within 6 months, with no further glycaemic benefits observed during 24 months of follow-up. Addition of insulin within 6 months of GLP-1RA initiation was associated with 18% higher odds of achieving HbA1c <7% at 24 months, compared with adding insulin later. At 24 months, those who added insulin reduced HbA1c significantly by 0.55%, while no glycaemic benefit was observed in those who switched to insulin. Irrespective of intensification with insulin, weight, SBP and LDL cholesterol were significantly reduced by 3 kg, 3 mm Hg, and 0.2 mmol/L, respectively, over 24 months.
CONCLUSIONS: Significant delay in intensification of treatment by addition of insulin is observed in patients with T2DM inadequately controlled with GLP-1RA. Earlier addition of insulin is associated with better glycaemic control, while switching to insulin is not clinically beneficial during 2 years of treatment. Non-responding patients on GLP-1RA would benefit from adding insulin therapy, rather than switching to insulin.
| Errataetall: |
CommentIn: Nat Rev Endocrinol. 2016 Nov 10;12 (12 ):689-690. - PMID 27831571 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Diabetes, obesity & metabolism - 19(2017), 1 vom: 01. Jan., Seite 108-117 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Montvida, Olga [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 07.11.2017 Date Revised 07.12.2022 published: Print-Electronic CommentIn: Nat Rev Endocrinol. 2016 Nov 10;12 (12 ):689-690. - PMID 27831571 Citation Status MEDLINE |
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| doi: |
10.1111/dom.12790 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM264348761 |
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| 100 | 1 | |a Montvida, Olga |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Addition of or switch to insulin therapy in people treated with glucagon-like peptide-1 receptor agonists |b A real-world study in 66 583 patients |
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| 500 | |a Date Completed 07.11.2017 | ||
| 500 | |a Date Revised 07.12.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Nat Rev Endocrinol. 2016 Nov 10;12 (12 ):689-690. - PMID 27831571 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2016 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Real world outcomes of addition or switch to insulin therapy in type 2 diabetes (T2DM) patients on glucagon-like paptide-1 receptor agonist (GLP-1RA) with inadequately controlled hyperglycaemia, are not known | ||
| 520 | |a MATERIALS AND METHODS: Patients with T2DM (n = 66 583) with a minimum of 6 months of GLP-1RA treatment and without previous insulin treatment were selected. Those who added insulin (n = 39 599) or switched to insulin after GLP-1RA cessation (n = 4706) were identified. Adjusted changes in glycated haemoglobin (HbA1c), weight, systolic blood pressure (SBP), and LDL cholesterol were estimated over 24 months follow-up | ||
| 520 | |a RESULTS: Among those who continued with GLP-1RA treatment without adding or switching to insulin, the highest adjusted mean HbA1c change was achieved within 6 months, with no further glycaemic benefits observed during 24 months of follow-up. Addition of insulin within 6 months of GLP-1RA initiation was associated with 18% higher odds of achieving HbA1c <7% at 24 months, compared with adding insulin later. At 24 months, those who added insulin reduced HbA1c significantly by 0.55%, while no glycaemic benefit was observed in those who switched to insulin. Irrespective of intensification with insulin, weight, SBP and LDL cholesterol were significantly reduced by 3 kg, 3 mm Hg, and 0.2 mmol/L, respectively, over 24 months | ||
| 520 | |a CONCLUSIONS: Significant delay in intensification of treatment by addition of insulin is observed in patients with T2DM inadequately controlled with GLP-1RA. Earlier addition of insulin is associated with better glycaemic control, while switching to insulin is not clinically beneficial during 2 years of treatment. Non-responding patients on GLP-1RA would benefit from adding insulin therapy, rather than switching to insulin | ||
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