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Primary‐care observational database study of the efficacy of GLP ‐1 receptor agonists and insulin in the UK
Author(s) -
Hall G. C.,
McMahon A. D.,
Dain M.P.,
Wang E.,
Home P. D.
Publication year - 2013
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12137
Subject(s) - medicine , observational study , primary care , insulin , receptor , pharmacology , endocrinology , family medicine
Aims We investigated use and efficacy of glucagon‐like peptide‐1 ( GLP ‐1) receptor agonists in UK practice. Methods People starting a GLP ‐1 receptor agonist (exenatide, liraglutide) or insulin (glargine, detemir, NPH ) after a regimen of two or three oral glucose‐lowering agents were identified from The Health Information Network observational primary care database (2007–2011). Mean change in HbA 1c and body weight were compared at 1 year between cohorts, adjusting for baseline characteristics. Results Baseline characteristics of GLP ‐1 receptor agonist ( n = 1123) vs. insulin ( n = 1842) users were HbA 1c 78 vs. 84 mmol/mol (9.3 vs. 9.8%) and BMI 38.2 vs. 30.9 kg/m 2 . The GLP ‐1 receptor agonist cohort was younger, had shorter diabetes duration and follow‐up, less microvascular disease and heart failure, higher estimated glomerular filtration rate and more use of oral glucose‐lowering agents. Lower HbA 1c reduction on GLP ‐1 receptor agonist [7 vs. 13 mmol/mol (0.6 vs. 1.2%) ( n = 366 vs. 892)] was not statistically significant [adjusted mean difference −1.4 (95% CI −4.1, 1.2) mmol/mol], except in the highest HbA 1c quintile [>96 mmol/mol (>10.9%); adjusted mean difference −17.8 (−28.6, −7.0) mmol/mol]. GLP ‐1 receptor agonist users lost weight [−4.5 vs. +1.5 kg; adjusted mean difference 4.7 (3.7, 5.8) kg; n = 335 vs. 634]. A UK 6‐month target reduction for GLP ‐1 receptor agonists of 11 mmol/mol (1.0%) HbA 1c and 3% weight was reached by 24.9% of those continuing treatment. Conclusions Those starting GLP ‐1 receptor agonists are heavier with better glycaemic control than those starting basal insulin. Subsequently, they have improved weight change, with similar HbA 1c reduction unless baseline HbA 1c is very high. The UK 6‐month GLP ‐1 receptor agonist target is usually not reached.