5 years ago

Impact of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist in patients with type 2 diabetes uncontrolled on basal insulin: a longitudinal study of a US administrative claims database

M. Bertolini, H. Wang, L. Tong, L.F. Meneghini, C. Pan, E. Lew
Aim To evaluate the effect of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) on clinical and economic outcomes in patients with type 2 diabetes (T2D). Methods We conducted a retrospective observational claims study using IMPACTTM, in adult patients with T2D who initiated basal insulin between 1 January 2005 and 31 December 2012 with or without OADs, but remained uncontrolled (glycated haemoglobin [HbA1c] ≥7.0%). Patients were categorized into three groups: early, delayed, and no intensification with a GLP-1 RA. We evaluated changes from baseline to 12 months’ follow-up for HbA1c level, rate of hypoglycaemic events, and healthcare costs, and assessed the association between baseline patient characteristics and subsequent treatment intensification. Results 139 (9.0% of 1552 eligible patients) met the criteria for inclusion in the early intensification group, 588 (37.9%) in the delayed intensification group, and 825 (53.2%) in the no intensification group. Mean baseline HbA1c values were 9.16%, 9.07%, and 9.34%, respectively. At follow-up, delayed intensification was associated with significantly smaller decreases in HbA1c from baseline (−0.68%) compared with early intensification (−1.01%). Rates of overall hypoglycaemia was numerically greater in delayed intensification group than in early intensification group (0.26 vs 0.06 events/patient-years of exposure, respectively).The change in semi-annual total healthcare costs was greater in the no intensification group (+US$5266) compared with the early intensification (−US$560) and delayed intensification groups (+US$1943). Conclusions Timely addition of a GLP-1 RA to therapy for patients with T2D not adequately controlled on basal insulin is associated with better clinical and economic outcomes.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/dom.13156

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