Impact of Liraglutide to Semaglutide Conversion on Glycemic Control and Cost Savings at a Veterans Affairs Medical Center.

Abstract

Background: Semaglutide and liraglutide are glucagon-like peptide 1 receptor agonists (GLP-1 RAs) approved by the US Food and Drug Administration for patients with type II diabetes mellitus (T2DM). Patients with T2DM treated with liraglutide at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) were converted to semaglutide. The primary objective was to assess changes in glycemic control and cost savings that resulted from this conversion.

Methods: We conducted a retrospective chart review of veterans without retinopathy treated at MEDVAMC between March 1, 2021, and November 30, 2021, who were converted from liraglutide 0.6 mg and 1.2 mg daily to semaglutide 0.25 mg weekly (titrated to 0.5 mg weekly after 4 weeks). We compared hemoglobin A_1c (HbA_1c) values at baseline and 3 to 12 months following conversion to assess glycemic control. Cost savings were evaluated using outpatient pharmacy data.

Results: During the study, 411 patients were converted from liraglutide to semaglutide; 49 additional patients met the criteria for clinician education, and 14 were converted as a result. In total, 304 patients met the criteria for inclusion. At baseline, patients' mean (SD) levels included: HbA_1c, 8.1% (1.5); blood glucose, 187.4 (44.2) mg/dL; and body weight, 112.9 (23.0) kg. Three to 12 months postconversion, patients' mean (SD) HbA_1c significantly decreased to 7.6% (1.4) (P < .001), blood glucose decreased to 172.6 (39.0) mg/dL (P < .001), and body weight decreased to 105.2 (32.3) kg (P < .001). Cost savings exceeding $400,000 resulted from liraglutide to semaglutide conversion.

Conclusions: Conversion of liraglutide to semaglutide led to significant HbA_1c decrease and weight loss and resulted in minimal changes to patients' antihyperglycemic regimen. Common adverse effects included hypoglycemia and gastrointestinal intolerance. Due to the low conversion rate of liraglutide to semaglutide following education, a more effective method of education for clinicians to promote teleretinal imaging before conversion is warranted. Lastly, although the semaglutide cost savings initiative at MEDVAMC resulted in significant savings for the institution, a full cost-effective analysis is needed for further conclusion.