Real-world weight change among patients treated with glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor and sulfonylureas for type 2 diabetes and the influence of medication adherence

Abstract

SummaryAimsThe study aims to examine real‐world weight change and the role of medication adherence among patients with type 2 diabetes who initiated one of three drug classes: glucagon‐like peptide‐1 receptor agonist (GLP‐1RA), dipeptidyl peptidase‐4 inhibitor (DPP4) and sulfonylureas (SUs).Materials and methodsA cohort of patients initiating one of the three drug classes was selected from a large US database of integrated electronic medical record and administrative claims. Adherence was defined as per cent of days covered ≥80% during the year following drug initiation. Weight change was calculated from drug initiation (−180, +30 d) to 1 year (±90 d) later. Multivariate regression controlled for baseline differences between adherent and poorly adherent patients and the addition of another drug class during follow‐up.ResultsThe study included 833 GLP‐1RA, 2,272 DPP4 and 2,713 SU patients who contributed 2,279, 6,602 and 7,429 observations respectively. Patients initiating a GLP‐1RA achieved the largest weight change (−2.46 kg of GLP‐1RA, −1.26 kg of DPP4 and 0.18 kg of SU, P < 0.01). Adherent GLP‐1 patients lost 1.73 kg more than poorly adherent patients, and adherent SU patients gained 1.11 kg more than poorly adherent patients (all P < 0.01). Adherent and poorly adherent DPP4 patients experienced approximately the same amount of weight loss.ConclusionsMedication adherence can mediate observed weight loss in patients treated with a GLP1‐RA or weight gain in those treated with an SU. Medication adherence was low in a real‐world population, particularly for GLP‐1RA, which displayed the strongest weight loss benefit. Because recent American Diabetes Association guidelines recommend selecting drug therapies that have a weight loss or weight neutral effect for the management of type 2 diabetes patients, patients should be encouraged to enhance their adherence to benefit the most from therapies that have weight loss properties.

Dulaglutide is an effective treatment for lowering HbA1c in patients with type 2 diabetes regardless of body mass index

“…In the real‐world clinical practice setting, this consistency in efficacy with dulaglutide 1.5 mg treatment regardless of BMI is important for patients and healthcare professionals, as GLP‐1 RA treatments are most frequently prescribed to patients with a BMI of ≥35 kg/m 2 . As the analyzed population included patients with a BMI of <30 kg/m 2 (36% overall), these data also suggest that dulaglutide 1.5 mg treatment is efficacious for patients regardless of BMI.…”

“…AW, AWARD study; BMI, body mass index; CI, confidence interval; DU, dulaglutide; ITT, intent to treat population; LS mean, least-squares mean; W, week for patients and healthcare professionals, as GLP-1 RA treatments are most frequently prescribed to patients with a BMI of ≥35 kg/m 2 . [7][8][9] As the analyzed population included patients with a BMI of <30 kg/m 2 (36% overall), these data also suggest that dulaglutide Weight management is an important part of managing type 2 diabetes. A post hoc analysis of patient data from the AWARD-1 to -6 studies investigated the relationship between weight change, HbA1c, and the effect of baseline characteristics on weight and HbA1c responses.…”

“…As most GLP‐1 RAs also have a clinically relevant effect on weight loss, clinicians tend to choose these treatment options for patients with a greater degree of obesity. In the real‐world clinical practice setting, the most frequent use of GLP‐1 RA treatment is in patients with a BMI above 35 kg/m 2 , with a lower frequency of use in patients with a BMI below 30 kg/m 2 (6 to 12%) …”

“…In the real-world clinical practice setting, the most frequent use of GLP-1 RA treatment is in patients with a BMI above 35 kg/m 2 , with a lower frequency of use in patients with a BMI below 30 kg/m 2 (6 to 12%). [7][8][9] By contrast, most randomized clinical studies investigating GLP-1 RA treatments included patients with a mean BMI between 30 and 35 kg/m 2 . 10,11 The objective of this exploratory analysis is to assess the relationship between HbA1c reduction and baseline BMI in patients treated with once-weekly dulaglutide 1.5 mg and dulaglutide 0.75 mg in eight AWARD studies.…”

More recent, better designed studies have weakened links between antidiabetes medications and cancer risk

“…Weight gain has also been reported as a side effect. This could confound any attempt to link the drug to cancer . A meta‐analysis of 72 studies of sulfonylureas found a 20% increased cancer risk (although with high heterogeneity: I 2 =95%), but in an analysis that comprised only the 38 RCTs, the association did not persist .…”