Prandial Insulin versus Glucagon-Like Peptide-1 Added to Basal Insulin: Comparative Effectiveness in the Community Practice Setting. Issue 6 (October 2014)

• Record Type: Journal Article
• Authors: Digenio, Andres; Karve, Sudeep; Candrilli, Sean D.; Dalal, Mehul
• Is Part Of: Postgraduate medicine. Volume 126:Issue 6(2014)
• Page Start: 49
• Page End: 59
• Publication Date: 2014-10
• Subjects: glucagon-like peptide-1 receptor agonist -- prandial insulin -- comparative effectiveness -- type 2 diabetes mellitus -- community practice -- electronic medical records; Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610.5
• DOI: 10.3810/pgm.2014.10.2820
• Languages: English
• ISSNs: 0032-5481

Abstract

Abstract: Background: Real-world data on emerging combination approaches for type 2 diabetes mellitus (T2DM) management are limited. The objective of the current study was to document the characteristics and clinical outcomes of patients with T2DM initiating prandial insulin or a glucagon-like peptide-1 (GLP-1) receptor agonist while on basal insulin.Methods: This was a retrospective analysis of an electronic medical records database of patients with T2DM managed in a community practice setting in the United States. The main outcome measures were glycated hemoglobin (HbA1c ), body weight, hypoglycemia, and health care resource utilization at baseline and at 6-month and 1-year follow-up.Results: A total of 33 810 patients were included in the study: 31 848 on prandial insulin and 1962 on a GLP-1 receptor agonist. At baseline there were significant differences in mean age (60 vs 56 years), mean Charlson Comorbidity Index score (1.1 vs 0.7), mean HbA1c (8.8% vs 8.4%), and mean body weight (99 vs 112 kg) between the prandial insulin and GLP-1 receptor agonist groups, respectively ( P < 0.001 for each). After matching for baseline differences, significant and similar changes from baseline were observed between the prandial insulin and the GLP-1 receptor agonist groups during follow-up at the 6 months/1 year post-index date for HbA1c (−0.45/−0.60% vs −0.44/−0.58%, respectively; P = 0.907/0.723 between groups). Body weight changes between the groups were significantly different at 6 months/1 year (+1.7/−1.7 vs −0.9/−3.7 kg; P < 0.001). Hypoglycemia incidence and health care resource utilization were significantly greater in the prandial insulin versus GLP-1 receptor agonist group.Conclusions: The results of this real-world analysis of patients with T2DM adding a GLP-1 receptor agonist or prandial insulin to basal insulin suggest an association between adding a GLP-1 receptor agonist with similar glycemic control, greater reduction in body weight, lower hypoglycemia incidence, and lower health care utilization compared with adding prandial insulin.