Predictive Factors of Insulin Discontinuation after Adding a GLP-1 Receptor Agonist in Patients with Type 2 Diabetes Treated with Insulin in Combination with Oral Antihyperglycemic Agents

Abstract

The aim of this 6-month (mo) retrospective study was to evaluate the effectiveness of GLP1 receptor agonists (GLP1RA) in patients with T2D treated with insulin plus oral antihyperglycemic drugs and to determine predictors of successful insulin discontinuation (ID), defined as the achievement of A1C <7% 6 mo after the initiation of the GLP1RA in those patients who stopped insulin over the follow-up. The best predictive model of successful ID was estimated by logistic regression. 159 patients were included, mean age 61.8 y, A1C 8.42%, BMI 36.7 kg/m2 and insulin dose 55.9 U/d; 61.6% received liraglutide, 25.2% exenatide BID and 13.2% exenatide QW. A1C (-0.99%) and weight (-4.2kg) significantly decreased at 6 mo. 19.5% of patients discontinued insulin (table), but only 7.5% of patients stopped insulin and maintained A1C<7% at 6 mo. Fasting plasma glucose, A1C, duration of T2D, duration of insulin therapy, insulin dose and diabetic renal disease were all negatively associated to successful ID in the univariate analysis, but only insulin dose remained significant in the multivariate analysis (OR 0.88, 95CI% 0.80-0.97). In summary, in a real-world setting, few patients treated with GLP1RA achieved good glycemic control after stopping insulin. Baseline insulin dose was the main baseline predictor of successful ID.Table. Characteristics of patients according to insulin discontinuation at 6 months. Data are percentage, mean (SD),median* (IQR) or mean difference (95%CI)**variablediscontinuationn 31 (19.5%)no discontinuationn 128 (80.5%)between-group difference (p )exenatide BID (%)liraglutide (%)exenatide QW (%)41.951.66.521.164.114.80.044 (between all GLP-1RA)women (%)74.252.30.028age (y)59.1 (10.9)62.5 (10.5)0.11duration of T2DM (y)*11.9 (5.9-16.3)16.4 (10.4-22.9)0.002duration of insulin therapy (y)*2.3 (0.9-7.9)5.7 (2.0-12.1)0.011insulin dose (U/d)31.2 (13.6)61.8 (43.4)<0.0001metformin (%)80.684.40.614sulfonylureas (%)48.428.90.038glitazones (%)16.16.30.072DPP-4 inhibitors (%)22.634.40.207diabetic renal disease (%)9.738.30.002baseline A1C (%)7.87 (1.56)8.53 (1.39)0.036A1C reduction (%) at 6 months**-0.20 (-0.88;0.49)-1.19 (-1.53;-0.84)0.011A1C<7% at 6 months (%)44.144.40.974baseline weight (kg)97.4 (22.0)95.3 (16.5)0.546weight loss (kg) at 6 months**-5.9 (-7.8;-4.0)-3.7 (-4.8;-2.6)0.068hypoglycemia (%)22.633.60.236GLP-1RA withdrawal (%)6.517.20.134 Disclosure J.J. Gorgojo-Martinez: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Other Relationship; Self; AstraZeneca. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Eli Lilly and Company. Other Relationship; Self; Eli Lilly and Company. Advisory Panel; Self; Merck Sharp & Dohme Corp.. Other Relationship; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc., Abbott, AbbVie Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Esteve, Roche Pharma. Advisory Panel; Self; Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Research Support; Self; Sanofi. Other Relationship; Self; Sanofi.