Treatment Outcomes and Tolerability Following Initiation of GLP-1 Receptor Agonists Among Type 2 Diabetes Patients in Primary Care Practices in Germany

Abstract

Background:The aim was to investigate real-world treatment outcomes and tolerability of GLP-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes in Germany. Methods:Patients from 323 primary care practices who started any GLP-1RA therapy (89 Byetta, 108 Bydureon, 347 Victoza patients) between January 1, 2011, and December 31, 2013 (index date) were analyzed retrospectively (Disease Analyzer database, Germany). Changes from baseline in HbA1c, weight, and hypoglycemia were evaluated in 3 follow-up periods of 0-6, 7-12, and 13-18 months.Results: A total of 544 diabetes patients (mean age: 57.9 years; men: 54%) were eligible for the study. Mean (SD) HbA1c (%) decreased from 8.3 (1.4) at baseline to 7.4 (1.2) in 6 months, 7.6 (1.3) in 7-12 months and 7.6 (1.4) in 13-18 months, respectively (P < .001 for all), while the proportion of patients with HbA1c <7% increased from 15% at baseline to 38%, 36% and 35% in the corresponding periods (P < .0001 for all). Multivariate-adjusted beta coefficients corresponding to changes in HbA1c (%) from baseline were -.52, -.44, and -.44, respectively, in the follow-up periods for baseline HbA1c (%) (P < .0001 for all). The prevalence of hypoglycemia at baseline was 0.7%; this did not change significantly after treatment. Conclusions:In clinical practice, GLP-1RA treatment was associated with improved glycemic control without increased hypoglycemia for up to 18 months. The higher the baseline HbA1c, the greater the HbA1c reduction recorded.

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

“…Consistent with both randomized clinical trials and retrospective studies, 12,13 the results from the present analyses indicate that, on average, initiation on a GLP-1 RA is associated with improved glycemic control. Notably, the improvement in HbA 1c value (−0.6%; P < 0.0001) observed in the present study was slightly less pronounced than in previous research, 12,13 potentially due to differences in study design, study length, and drug adherence rates. In addition, our findings suggest that earlier initiation on a GLP-1 RA, as proxied by the use of fewer classes of GLAs in the preperiod, is associated with a and likelihood of glycosylated hemoglobin (HbA 1c ) value < 7.0% in the postperiod.…”

Liraglutide effects on glycemic control and weight in patients with type 2 diabetes Mellitus: A real-world, observational study and brief narrative review

“…Most of the studies assessed liraglutide without an active comparator. One study [16] evaluated pooled outcomes associated with GLP-1 RA therapy (liraglutide, exenatide, and once-weekly exenatide). Another study [17] compared the effectiveness of liraglutide, dulaglutide, and exenatide.…”

“…Another study [17] compared the effectiveness of liraglutide, dulaglutide, and exenatide. Most studies [16][17][18][19][20][21][22] showed statistically significant differences in glycemic control after liraglutide treatment.…”

Development of Biomarkers for Inhibition of SLC6A19 (B0AT1)—A Potential Target to Treat Metabolic Disorders

“…This is caused by reduced absorption of amino acids, resulting in a higher luminal load of neutral amino acids, which act as signalling molecules to release GLP-1 from enteroendocrine cells [ 25 ]. FGF21 and GLP-1 are currently being used for the treatment of diabetes or are in clinical trials [ 26 , 27 ]. SLC6A19 is also present in the early sections of the kidney proximal tubule where it reabsorbs amino acids back into the blood from the ultra-filtrate generated in the glomeruli of the kidney cortex.…”