Real-World Comparisons Between Glucagon-Like Peptide-1 Receptor Agonists and Other Glucose-Lowering Agents in Type 2 Diabetes: Retrospective Analyses of Cardiovascular and Economic Outcomes in England.

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2025-03-21 DOI:10.1007/s13300-025-01715-w

Derek Connolly, Edward Collins, Hongye Ren, Simon Wan Yau Ming, Jennifer Davidson, Steve Bain

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引用次数: 0

Abstract

Introduction: Clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes (T2D) who have established cardiovascular disease (CVD) or a high risk of CVD. Nevertheless, GLP-1RAs remain underutilized. This real-world, retrospective study compared cardiovascular and economic outcomes between individuals treated with GLP-1RAs and other glucose-lowering agents in England.

Methods: Clinical Practice Research Datalink-registered people indexed on GLP-1RAs, dipeptidyl peptidase-4 (DPP4) inhibitors, or basal insulin between January 1, 2014 and December 31, 2018 for their fourth line of T2D treatment were stratified into six cohorts based on their: (1) cardiovascular risk (high or very high risk) and (2) indexed therapy. Cox proportional hazards regression was used to compare the risk of MACE and all-cause death between GLP-1RA and other treatment cohorts. Generalized linear regression was used to quantify differences in healthcare resource use (HCRU) and costs between groups.

Results: Of 63,237 subjects, 10,607 were at high cardiovascular risk (GLP-1RA: 2709; DPP4 inhibitor: 2673; basal insulin: 5225) and 52,630 at very high cardiovascular risk (GLP-1RA: 14,692; DPP4 inhibitor: 18,461; basal insulin: 19,477). The crude incidence of all outcomes was lower in the GLP-1RA versus other treatment cohorts, regardless of cardiovascular risk. Among very-high-risk individuals treated with GLP-1RA, the adjusted risk of MACE was 33% (24-40%) and 23% (13-23%) lower versus DPP4 inhibitor and basal insulin cohorts, respectively. The adjusted total cardiovascular-related cost among very-high-risk individuals was £208.14 (£155.81-£260.47) and £151.74 (£110.69-£192.79) lower in the GLP-1RA versus DPP4 inhibitor or basal insulin cohorts, respectively.

Conclusions: In a real-world setting, GLP-1RAs may be associated with a lower risk of MACE and reduced HCRU and costs than DPP4 inhibitors or basal insulin in individuals with T2D, particularly among those at very high cardiovascular risk.

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2型糖尿病中胰高血糖素样肽-1受体激动剂和其他降糖药的现实世界比较：英国心血管和经济结果的回顾性分析

临床试验表明，胰高血糖素样肽-1受体激动剂（GLP-1RAs）可降低已确诊心血管疾病（CVD）或CVD高风险的成人2型糖尿病（T2D）患者发生主要不良心血管事件（MACE）的风险。然而，GLP-1RAs仍未得到充分利用。这项真实世界的回顾性研究比较了英国接受GLP-1RAs和其他降糖药治疗的个体的心血管和经济结果。方法：2014年1月1日至2018年12月31日期间，临床实践研究数据链注册的GLP-1RAs，二肽基肽酶-4 （DPP4）抑制剂或基础胰岛素为第四线T2D治疗索引的患者根据其：(1)心血管风险（高风险或非常高风险）和(2)索引治疗分为六个队列。采用Cox比例风险回归比较GLP-1RA组与其他治疗组间MACE和全因死亡的风险。使用广义线性回归来量化组间医疗资源使用（HCRU）和成本的差异。结果：在63,237名受试者中，10,607人处于高危心血管疾病(GLP-1RA: 2709；DPP4抑制剂：2673；基础胰岛素：5225)和52630名心血管风险极高的患者(GLP-1RA: 14692；DPP4抑制剂：18461；基础胰岛素：19477)。无论心血管风险如何，GLP-1RA组的所有结果的粗发生率均低于其他治疗组。在接受GLP-1RA治疗的高危人群中，与DPP4抑制剂和基础胰岛素组相比，MACE的调整风险分别降低33%（24-40%）和23%（13-23%）。与DPP4抑制剂或基础胰岛素组相比，GLP-1RA组高危人群调整后的心血管相关总成本分别降低了208.14英镑（155.81英镑- 260.47英镑）和151.74英镑（110.69英镑- 192.79英镑）。结论：在现实世界中，与DPP4抑制剂或基础胰岛素相比，GLP-1RAs可能与T2D患者MACE风险降低、HCRU和成本降低有关，特别是在心血管风险非常高的人群中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.