Abstract
AimsWe investigated use and efficacy of glucagon-like peptide-1 (GLP-1) receptor agonists in UK practice.MethodsPeople starting a GLP-1 receptor agonist (exenatide, liraglutide) or insulin (glargine, detemir, NPH) after a regimen of two or three oral glucose-lowering agents were identified from The Health Information Network observational primary care database (2007–2011). Mean change in HbA1c and body weight were compared at 1 year between cohorts, adjusting for baseline characteristics.ResultsBaseline characteristics of GLP-1 receptor agonist (n = 1123) vs. insulin (n = 1842) users were HbA1c 78 vs. 84 mmol/mol (9.3 vs. 9.8%) and BMI 38.2 vs. 30.9 kg/m2. The GLP-1 receptor agonist cohort was younger, had shorter diabetes duration and follow-up, less microvascular disease and heart failure, higher estimated glomerular filtration rate and more use of oral glucose-lowering agents. Lower HbA1c reduction on GLP-1 receptor agonist [7 vs. 13 mmol/mol (0.6 vs. 1.2%) (n = 366 vs. 892)] was not statistically significant [adjusted mean difference −1.4 (95% CI −4.1, 1.2) mmol/mol], except in the highest HbA1c quintile [>96 mmol/mol (>10.9%); adjusted mean difference −17.8 (−28.6, −7.0) mmol/mol]. GLP-1 receptor agonist users lost weight [−4.5 vs. +1.5 kg; adjusted mean difference 4.7 (3.7, 5.8) kg; n = 335 vs. 634]. A UK 6-month target reduction for GLP-1 receptor agonists of 11 mmol/mol (1.0%) HbA1c and 3% weight was reached by 24.9% of those continuing treatment.ConclusionsThose starting GLP-1 receptor agonists are heavier with better glycaemic control than those starting basal insulin. Subsequently, they have improved weight change, with similar HbA1c reduction unless baseline HbA1c is very high. The UK 6-month GLP-1 receptor agonist target is usually not reached.
Highlights
The short-term aim of therapy for hyperglycaemia is improved blood glucose control without significant tolerability or safety issues, and with the longer-term objective of reducing vascular damage
Those starting Glucagon-like peptide-1 (GLP-1) receptor agonists are heavier with better glycaemic control than those starting basal insulin
Initial pharmaceutical therapy is with an oral glucose-lowering agent, a steady decline in islet b-cell function results in progressive hyperglycaemia, which requires a stepwise escalation of treatment
Summary
The short-term aim of therapy for hyperglycaemia is improved blood glucose control without significant tolerability or safety issues, and with the longer-term objective of reducing vascular damage. Initial pharmaceutical therapy is with an oral glucose-lowering agent, a steady decline in islet b-cell function results in progressive hyperglycaemia, which requires a stepwise escalation of treatment. Insulin is often required as the only therapy independent of the need for endogenous insulin production. Glucagon-like peptide-1 (GLP-1) receptor agonists have recently become a therapy option, with exenatide introduced into the UK market in 2007 and liraglutide in 2009. GLP-1 receptor agonists mimic, at supra-physiological levels, the. A review of 28 randomized clinical trials reported that GLP-1 receptor agonist therapy reduced HbA1c by approximately 11 mmol/mol (1.0%), with weight loss of 2.3–5.5 kg a 2013 The Authors.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
