Glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes:real-world evidence from a Mediterranean area

Abstract

Aims: To assess clinical characteristics and factors associated with glycated hemoglobin (HbA1c) reduction in type 2 diabetes (T2DM) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1RAs).

Methods: Retrospective cohort study in patients with T2DM who initiated GLP-1RAs between 2007 and 2014 in primary health care centers in Catalonia (Spain). We evaluated changes in HbA1c and body weight at 6–12 months, and factors independently associated with achieving ≥1% HbA1c target reduction.

Results: Overall, 4242 patients (47.9% male; mean BMI 37.5 kg/m²) initiated a GLP-1RA. At 6–12 months, the mean HbA1c level decreased from the baseline 8.8% to 7.7% (−1.0%; SD = 1.6). A 1% reduction in HbA1c was observed in 47.2% of patients. Patients lost a mean of 3.6 kg (SD = 6.2). Sixty percent of patients reduced both HbA1c and body weight, and 17% achieved only one of these targets. Independent determinants of a 1% HbA1c reduction were baseline HbA1c, age, diabetes duration and being on insulin treatment. Reduction in weight or HbA1c and the proportion of patients achieving a HbA1c reduction of ≥1% was significantly larger among subjects prescribed liraglutide than exenatide and lixisenatide.

Conclusions: In this real-world, retrospective study, the magnitude of HbA1c and body weight reductions after addition of a GLP-1RA were similar to those observed in randomized controlled trials. Approximately 60% of patients attained reductions in both HbA1c and body weight, and there were significant differences among different drugs from this therapeutic group.

Keywords:

• GLP-1 analogue
• type 2 diabetes mellitus
• primary care
• observational study
• glycemic control

Transparency

Author contributions

M.M.-C., J.F.-N., E.O. and D.M. contributed to study design. J.R., B.V. and M.G. were involved in data management and statistical analyses. All authors contributed to the analysis and interpretation of the data, provided critical input during the development of the manuscript and approved the final version for submission. M.M.-C. had full access to all data in the study and takes responsibility for the integrity of data and the accuracy of the data analysis.

Declaration of financial/other relationships

M.M.-C. has disclosed that he has received advisory honoraria from Astra-Zeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; speaker honoraria from Astra-Zeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, Menarini, MSD, Novartis, Novo Nordisk and Sanofi; and research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi. J.F.-N. has disclosed that he has received advisory and/or speaking fees from Astra-Zeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; and research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. D.M. has disclosed that he has received advisory and/or speaking fees from Astra-Zeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk and Sanofi; and research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi and Boehringer. E.O. has disclosed that he has received advisory and/or speaking fees from Astra-Zeneca, Boehringer Ingelheim, Lilly, MSD, Novo Nordisk, Sanofi and Amgen; and research grants to the institution from MSD and Amgen. J.R., B.V. and M.G. have no conflict of interest to declare.

Availability of data

The data that support the findings of this study are available from the SIDIAP database (System for the Development of Research in Primary Care). Restrictions apply to the availability of these data, which were used under license for this study.

Acknowledgements

This study was possible thanks to the commitment of physicians and nurses working in the Catalan Health Institute who provide care to patients with diabetes. The authors acknowledge Amanda Prowse (Lochside Medical communications Ltd.) for providing support in the paper editing.

Additional information

Funding

This study was supported by the Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), and partially funded and sponsored by Novo Nordisk Spain. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review or approval of the manuscript. CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative from Instituto de Salud Carlos III, Madrid, Spain.