3 years ago

Effect of adding GLP-1RA on mortality, cardiovascular events and metabolic outcomes among insulin-treated patients with Type 2 Diabetes: A Large Retrospective UK Cohort Study

Combining a GLP-1 receptor agonist (GLP-1RA) with insulin is often an effective treatment strategy for overweight patients with Type 2 diabetes, but little is known about the longer term effects on cardiovascular and mortality outcomes in routine clinical practice in the UK. We therefore compared the times to a major non-fatal CV event and all-cause mortality among overweight patients with Type 2 diabetes (T2D) treated with insulin alone versus insulin+GLP-1RA in a large UK database. Methods A retrospective cohort study was conducted in 18,227 patients with insulin-treated T2D from UK General Practices using The Health Improvement Network (THIN) database The 5-year risk of mortality and a three-point composite of all-cause mortality and non-fatal CV outcomes (MI or stroke) was compared between a propensity score-matched cohort of those on insulin alone (N=1793) and insulin+GLP-1RA (N=1793), irrespective of other diabetes therapies, providing a total of 12,682 person-yrs. of follow up. Cox proportional hazard models were used to estimate the hazard ratios of the outcomes. Results HbA1c reduction was similar between both groups (−0.42 vs −0.33%, P =.089 at 12months). Overall, three-point composite events of all-cause mortality and CV events (MACE) were 98 vs 55 for the insulin alone vs insulin+GLP-1RA groups respectively (14.7 vs 9.2 per 1000 person-yrs.; adjusted Hazard Ratio (aHR): 0.64; 95%CI: 0.42–0.98; P =.038). Corresponding composite non-fatal CV events were 33vs 28 (6.0 vs 5.6 per 1000 person-yrs.; aHR: 0.76; 95%CI: 0.41–1.42; P =.393) while all-cause mortality events were 49 vs 13 (6.9 vs 2.0 per 1000 person-yrs.; aHR: 0.35; 95%CI: 0.17–0.73; P =.005). Conclusion Based on a large UK cohort in routine clinical practice, adding a GLP-1RA to insulin therapy is associated with a reduction in risk of composite CV events and all-cause mortality, but non-significant higher risk of hospitalisation for heart failure in overweight patients with Type 2 diabetes.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317303150

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