Association of Changes in A1C Following Continuous Glucose Monitoring Acquisition in People with Sub-Optimally Treated Type 2 Diabetes Taking GLP-1 RA Therapy.

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI:10.1007/s13300-024-01619-1

Eden Miller, Joyce S Chuang, Gregory J Roberts, Yelena Nabutovsky, Naunihal Virdi, Eugene E Wright

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Abstract

Introduction: Both glucagon-like peptide-1 receptor agonists (GLP-1 RA) and continuous glucose monitoring (CGM) improve glycemia in patients with type 2 diabetes (T2D). However, it is unknown whether adding CGM to GLP-1 RA therapy further improves A1c. We evaluated changes in A1c levels 6 months after initiation of FreeStyle Libre (FSL) in adults with sub-optimally controlled T2D already on GLP-1 RA therapy.

Methods: This retrospective, observational study used Optum's de-identified Market Clarity Data, a linked electronic health record-claims database to assess changes in A1c after FSL acquisition. Inclusion criteria were T2D diagnosis, ≥ 18 years, baseline A1c ≥ 8%, with the first FSL acquisition between 2018 and 2022. Patients were required to be on GLP-1 RA prior to FSL with at least one GLP-1 RA prescription within 90 days of FSL acquisition. GLP-1 RA initiation was defined as the earliest GLP-1 RA prescription from 2017 onwards. Paired changes in A1c were assessed at 6 months after initial FSL acquisition.

Results: The study cohort included 1454 adults with T2D (age 55 ± 10 years, 52% male, 38% with intensive insulin therapy, median 471 days from GLP-1 RA initiation to FSL, and baseline A1c 9.8 ± 1.5%). After FSL acquisition, patients experienced an A1c decrease of 1.5 ± 1.9% (p < 0.001). Patients with a baseline A1c > 10% had the largest reduction (n = 497, - 2.7 ± 2.2%, p < 0.001). Significant improvements were observed in subgroups based on insulin therapy and GLP-1 RA formulation. Those initiating GLP-1 RA therapy > 24 months before FSL acquisition also showed improvements in A1c (n = 478; - 1.3 ± 1.7%, p < 0.001).

Conclusions: In a large, real-world study of adults with T2D, those on prior GLP-1 RA therapy experienced significant A1c improvements after acquiring FSL, irrespective of GLP-1 RA duration, GLP-1 RA formulation, or insulin therapy type. These findings support the use of FSL in adults with T2D treated with GLP-1 RA.

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接受 GLP-1 RA 治疗的亚光学治疗 2 型糖尿病患者在连续血糖监测采集后 A1C 变化的相关性。

导言：胰高血糖素样肽-1 受体激动剂（GLP-1 RA）和连续血糖监测（CGM）都能改善 2 型糖尿病（T2D）患者的血糖。然而，在 GLP-1 RA 治疗的基础上添加 CGM 是否能进一步改善 A1c 还不得而知。我们评估了已接受 GLP-1 RA 治疗、血糖控制欠佳的 T2D 成人在开始使用 FreeStyle Libre（FSL）6 个月后 A1c 水平的变化：这项回顾性观察研究使用 Optum 的去标识化 Market Clarity 数据（一个链接的电子健康记录-索赔数据库）来评估 FSL 使用后 A1c 的变化。纳入标准为确诊为 T2D，年龄≥ 18 岁，基线 A1c ≥ 8%，在 2018 年至 2022 年期间首次获得 FSL。患者在获得 FSL 之前必须服用 GLP-1 RA，且在获得 FSL 后 90 天内至少开过一次 GLP-1 RA 处方。GLP-1 RA 的开始定义为从 2017 年起最早的 GLP-1 RA 处方。在首次获得 FSL 后 6 个月评估 A1c 的配对变化：研究队列包括1454名T2D成人患者（年龄55±10岁，52%为男性，38%接受强化胰岛素治疗，从开始使用GLP-1 RA到FSL的中位数为471天，基线A1c为9.8±1.5%）。获得 FSL 后，患者的 A1c 下降了 1.5 ± 1.9% (p 10% 的患者 A1c 下降幅度最大 (n = 497, - 2.7 ± 2.2%, p 获得 FSL 24 个月前，患者的 A1c 也有所改善 (n = 478; - 1.3 ± 1.7%, p 结论：在一项针对成人 T2D 患者的大型真实世界研究中，无论 GLP-1 RA 的持续时间、GLP-1 RA 的配方或胰岛素治疗类型如何，接受过 GLP-1 RA 治疗的患者在获得 FSL 后，A1c 均有显著改善。这些研究结果支持在接受 GLP-1 RA 治疗的成人 T2D 患者中使用 FSL。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.