Review of clinical use of glucagon-like peptide-1 in the management of type 2 diabetes

Abstract

Within the last decade, multiple new medications have been licensed for treating type 2 diabetes. These agents are vastly more expensive than their predecessors and usage requires review in practice. This retrospective case series reviewed 55 patients to assess the effect of glucagon-like peptide-1 (GLP-1) mimetics as add-on to existing antidiabetic therapy, including insulin, in clinical practice. The primary outcome measures were change in HbA1c and weight. Analyses were also conducted to test the effect of: initial HbA1c; concomitant insulin use; GLP-1 prescribed; and duration of diabetes on the change in HbA1c and weight. Mean BMI at initiation was 39.7 kg/m2; duration of diabetes at initiation 8.2 years; duration of GLP-1 therapy at review 18.3 months. The mean changes in HbA1c (-15.9 mmol/mol) and weight (-5.5 kg) were both highly significant (p < 0.0001). NICE targets for HbA1c and weight reductions were met in 34.5%. Significant negative correlations were found between initial HbA1c and subsequent change in HbA1c (p = 0.0001) and between initial BMI and subsequent change in weight (p = 0.04), whereas a significant positive correlation was observed between initial HbA1c and subsequent change in weight (p = 0.01). No statistically significant changes in HbA1c or weight were observed in relation to: concomitant insulin use; GLP-1 prescribed; or duration of diabetes. This study confirms GLP-1 agents provide clinically useful reductions in HbA1c and weight. Further work is required to assess their effect if used earlier. A practical and pragmatic approach to assessment of the effectiveness of GLP-1 has been proposed. Copyright © 2014 John Wiley & Sons, Ltd.