The Relationship Between Timing of Initiation on a Glucagon-like Peptide-1 Receptor Agonist and Glycosylated Hemoglobin Values Among Patients With Type 2 Diabetes

Abstract

Purpose: This study examines the relationship between timing of initiation on a glucagon-like peptide-1 receptor agonist (GLP-1 RA) and glycosylated hemoglobin (HbA 1c ) values.Methods: The IBM MarketScan databases were used to identify adults with type 2 diabetes mellitus (T2DM) who initiated GLP-1 RA therapy and had multiple recorded HbA 1c results. Time to GLP-1 RA initiation was proxied by the number of classes of glucose-lowering agents prescribed in the 2 years before GLP-1 RA initiation, with fewer glucoselowering agents indicating initiation of a GLP-1 RA earlier in disease progression. Paired t tests examined differences in HbA 1c values from preperiod to 2-year postperiod. Multivariable analyses examined the relationship between time to GLP-1 RA initiation and postperiod HbA 1c values.Findings: Initiation on a GLP-1 RA was associated with a 0.6% reduction in HbA 1c values over 2 years (P < 0.0001). Earliest starts were associated with a 1.3% reduction in HbA 1c levels (P < 0.0001) and the highest likelihood of achieving a postperiod HbA 1c level <7% (odds ratio, 4.9; 95% CI, 3.0e8.1).Implications: Results indicate that although initiation on a GLP-1 RA is generally associated with reduced HbA 1c levels, there may be additional clinical benefits associated with earlier initiation of a GLP-1 RA.

Saudi Consensus for Oral Semaglutide, the Recent Innovation in GLP-1 RAs Era; Consensus Report

“…Early initiation had the highest odds of obtaining a post-period HbA1c level of 7% (odds ratio, 4.9; 95% CI, 3.0 -8.1) and a reduction in HbA1c levels of 1.3 percent (p < 0.0001). The findings show that although starting a GLP-1RA is typically linked to lower HbA1c levels, starting a GLP-1RA earlier may have additional therapeutic advantages [51].…”

Early type 2 diabetes treatment intensification with glucagon‐like peptide‐1 receptor agonists in primary care: An Australian perspective on guidelines and the global evidence

“…Findings from a recent retrospective study provide further support for early‐line initiation of GLP‐1RAs. Use of GLP‐1RAs as a first‐ or second‐line therapy was associated with significantly greater reductions in HbA1c percentage from baseline and an increased likelihood of achieving an HbA1c value of less than 7% (< 53 mmol/mol), compared with initiation as a third‐ or fourth‐line therapy 26 …”

“…Use of GLP-1RAs as a first-or second-line therapy was associated with significantly greater reductions in HbA1c percentage from baseline and an increased likelihood of achieving an HbA1c value of less than 7% (< 53 mmol/mol), compared with initiation as a third-or fourth-line therapy. 26 The effects of second-line combination therapies with metformin on weight and HbA1c were compared in the prospective, observational, global DISCOVER study. At 36 months, all second-line combinations (GLP-1RAs, SGLT2is, DPP4is and sulphonylureas) with metformin showed similar mean reductions in HbA1c values of between -0.8% and -1.0%, with the largest reduction of around -1.4% observed at 6 months with metformin + GLP-1RA, compared with between -0.75% and -0.95% for the other combinations at this time point.…”

¿Qué nos han demostrado los arGLP-1 en el abordaje integral temprano?

“…Si examinamos su relación con una iniciación más temprana, representada por el uso de menos antidiabéticos en el preperíodo antes de iniciar el tratamiento con arGLP-1 y la probabilidad de tener un valor de HbA1c < 7 %, el inicio más temprano de un arGLP-1 se asoció con una mayor probabilidad de tener un valor de HbA1c < 7 %. Por ejemplo, los pacientes que se iniciaron antes, según el criterio de no haber usado antidiabéticos en el período anterior de iniciar el tratamiento con arGLP-1, tenían un 390 % más de probabilidades de tener un valor de HbA1c < 7 % en comparación con los tratados con ≥ 4 clases; mientras que los pacientes tratados con 3 clases de antidiabéticos en el preperíodo, tenían un 80 % más de probabilidades de tener un valor de HbA1c < 7 % en comparación con los tratados con ≥ 4 clases 70 .…”