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Aim  To assess the impact of the timing of initiating both basal insulin and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) on reaching glycaemic control targets over 6 and 12 months in people with type 2 diabetes (T2D) uncontrolled on oral antihyperglycaemic drugs with an HbA1c of 9% or higher.    Methods  This retrospective cohort study assessed the impact of the timing of initiating both basal insulin and GLP‐1 RA therapies on reaching glycaemic targets (HbA1c < 7% and <8%, and ≥1% and ≥2% HbA1c reduction) over 12 months in people with markedly uncontrolled T2D (HbA1c ≥ 9%) on oral antihyperglycaemic drugs identified on the Optum Humedica database (electronic medical records; 1 January 2011 to 30 June 2017). Study cohorts were defined by the days between initiating each injectable: cohort A, 30 days or less (simultaneous initiation) and cohorts B, 31‐90, C, 91‐180, D, 181‐270 and E, 271‐360 days (sequential initiation).    Results  Cohort A had the best glycaemic outcomes at 6 and 12 months for all four endpoints, followed by cohort B. The likelihood of achieving an HbA1c of less than 7% did not significantly differ between cohorts A and B (hazard ratio [95% confidence interval]: 0.87 [0.76‐1.01]); cohorts C, D and E were significantly less likely to achieve an HbA1c of less than 7% than cohort A (0.62 [0.53‐0.72]; 0.62 [0.53‐0.72]; 0.63 [0.54‐0.73]).    Conclusions  In people with uncontrolled T2D requiring treatment with a GLP‐1 RA and basal insulin, greater improvements in glycaemic control were observed when both therapies were initiated within close proximity of one another (≤90 days) compared with initiation 91‐360 days apart.

diabetes, obesity and metabolism

Real‐world evidence of the effectiveness on glycaemic control of early simultaneous versus later sequential initiation of basal insulin and glucagon‐like peptide‐1 receptor agonists