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Addition of or switch to insulin therapy in people treated with glucagon-like peptide-1 receptor agonists : a real-world study in 66 583 patients
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Montvida, Olga, Klein, Kerenaftali, Kumar, Sudhesh, Khunti, Kamlesh and Paul, Sanjoy K. (2017) Addition of or switch to insulin therapy in people treated with glucagon-like peptide-1 receptor agonists : a real-world study in 66 583 patients. Diabetes, obesity & metabolism, 19 (1). pp. 108-117. doi:10.1111/dom.12790 ISSN 1463-1326.
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Official URL: http://dx.doi.org/10.1111/dom.12790
Abstract
Background
Real world outcomes of addition or switch to insulin therapy in type 2 diabetes (T2DM) patients on glucagon-like paptide-1 receptor agonist (GLP-1RA) with inadequately controlled hyperglycaemia, are not known.
Materials and methods
Patients with T2DM (n = 66 583) with a minimum of 6 months of GLP-1RA treatment and without previous insulin treatment were selected. Those who added insulin (n = 39 599) or switched to insulin after GLP-1RA cessation (n = 4706) were identified. Adjusted changes in glycated haemoglobin (HbA1c), weight, systolic blood pressure (SBP), and LDL cholesterol were estimated over 24 months follow-up.
Results
Among those who continued with GLP-1RA treatment without adding or switching to insulin, the highest adjusted mean HbA1c change was achieved within 6 months, with no further glycaemic benefits observed during 24 months of follow-up. Addition of insulin within 6 months of GLP-1RA initiation was associated with 18% higher odds of achieving HbA1c <7% at 24 months, compared with adding insulin later. At 24 months, those who added insulin reduced HbA1c significantly by 0.55%, while no glycaemic benefit was observed in those who switched to insulin. Irrespective of intensification with insulin, weight, SBP and LDL cholesterol were significantly reduced by 3 kg, 3 mm Hg, and 0.2 mmol/L, respectively, over 24 months.
Conclusions
Significant delay in intensification of treatment by addition of insulin is observed in patients with T2DM inadequately controlled with GLP-1RA. Earlier addition of insulin is associated with better glycaemic control, while switching to insulin is not clinically beneficial during 2 years of treatment. Non-responding patients on GLP-1RA would benefit from adding insulin therapy, rather than switching to insulin.
Item Type: | Journal Article | ||||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Dean's Office & Professional Support Services Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||||||
Journal or Publication Title: | Diabetes, obesity & metabolism | ||||||||||
Publisher: | Wiley | ||||||||||
ISSN: | 1463-1326 | ||||||||||
Official Date: | January 2017 | ||||||||||
Dates: |
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Volume: | 19 | ||||||||||
Number: | 1 | ||||||||||
Page Range: | pp. 108-117 | ||||||||||
DOI: | 10.1111/dom.12790 | ||||||||||
Status: | Peer Reviewed | ||||||||||
Publication Status: | Published | ||||||||||
Reuse Statement (publisher, data, author rights): | "This is the peer reviewed version of the following article:Montvida, O, Klein, K, Kumar, S, Khunti, K and Paul, SK. Addition of or switch to insulin therapy in people treated with glucagon‐like peptide‐1 receptor agonists: A real‐world study in 66 583 patients, 2017; 19( 1): 108– 117., which has been published in final form at http://dx.doi.org/10.1111/dom.12790. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." | ||||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||||
Date of first compliant deposit: | 6 November 2019 | ||||||||||
Date of first compliant Open Access: | 6 November 2019 |
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