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Determinants of response to the glucagon-like peptide-1 receptor agonists in a type 2 diabetes population in the real-world

  • Author Footnotes
    1 These authors contributed equally to this study.
    Josep Franch-Nadal
    Footnotes
    1 These authors contributed equally to this study.
    Affiliations
    DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain

    Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Av. de les Drassanes, 17-21, 08001 Barcelona, Spain

    Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this study.
    Minerva Granado-Casas
    Footnotes
    1 These authors contributed equally to this study.
    Affiliations
    DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain

    Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain

    Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRB Lleida, University of Lleida, Av. Rovira Roure, 80, 25198 Lleida, Spain

    Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
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  • Manel Mata-Cases
    Affiliations
    DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain

    Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain

    Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Pl. Maria Angels Rosell Simplicio, 1, 08930 Barcelona, Spain
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  • Emilio Ortega
    Affiliations
    Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, C/ de Villarroel, 170, 08036 Barcelona, Spain

    Center for Biomedical Research on Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos, 3–5. Pabellón 11. Planta 0, 28029 Madrid, Spain
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  • Bogdan Vlacho
    Affiliations
    DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain
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  • Didac Mauricio
    Correspondence
    Corresponding author at: DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain.
    Affiliations
    DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Institut Universitari per a la Recerca a l’Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), C/ Sardanya 375, 08025 Barcelona, Spain

    Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain

    Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer de Sant Quintí, 89, 08041 Barcelona, Spain

    Faculty of Medicine, University of Vic (UVIC/UCC), Ctra. de Roda, 70, 08500 Vic, Spain
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  • Author Footnotes
    1 These authors contributed equally to this study.
Published:November 03, 2022DOI:https://doi.org/10.1016/j.pcd.2022.10.005

      Highlights

      • The effectiveness of GLP-1RAs in real-world data is scarce.
      • There is a need for assessment of treatment cost-effectiveness with GLP-1RAs.
      • A high baseline HbA1c and previous non-insulin therapy were the main predictors of a greater response to GLP-1ARs.
      • Weight, age, and kidney function were also related to this response.
      • As expected, good adherence to GLP-1RAs treatment resulted in improved results.

      Abstract

      Aims

      To identify clinical predictors associated with a response in terms of glycemic control and weight loss in patients with type 2 diabetes treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs).

      Methods

      A retrospective observational study was performed with real-world databases in primary care. Patients with type 2 diabetes-initiated treatment with GLP-1RAs during the study period, and response to GLP-1RAs were determined six months from treatment initiation. An optimal glycated hemoglobin (HbA1c) or weight response was defined as a reduction of ≥ 1% or ≥ 3%, respectively. A “great” response was defined as both an optimal HbA1c and weight response. Bivariate and multivariate analyses with intention-to-treat were performed.

      Results

      A sample of 2944 patients with type 2 diabetes was recruited. Higher HbA1c at baseline was the main clinical predictor of an optimal HbA1c response (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.96–2.71 in men and OR: 2.03, 95% CI: 1.76–2.33 in women). Treatment without insulin at baseline was associated with a greater weight reduction in men (OR: 2.50, 95% CI: 1.41–4.44). Older age and a higher weight at baseline were related with this in women (OR: 1.02, 95% CI: 1.00–1.05 and OR: 1.01, 95% CI: 1.00–1.02, respectively).

      Conclusions

      A high HbA1c at baseline and previous non-insulin therapy were the main predictors of a greater response (optimal HbA1c and weight response) to GLP1ra in both men and women. This may aid in treatment decision-making before initiating treatment with GLP-1RAs.

      Abbreviations:

      ADA (American Diabetes Association), BMI (body mass index), CI (confidence interval), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), DPP4i (dipeptidyl peptidase-4 inhibitors), EASD (European Association for the Study of Diabetes), eGFR (estimated glomerular filtration rate), FDA (Food and Drug Agency), GLP-1RAs (glucagon-like peptide-1 receptor agonists), HbA1c (glycated hemoglobin), ICS (Primary Health Care Centers of the Catalan Health Institute), ITT (intent-to-treat), MPR (Medication Possession Ratio), NIADs (non-insulin antidiabetic drugs), NICE (National Institute for Health and Care Excellence), OR (odds ratio), RCTs (randomized controlled trials), SIDIAP (System for the Development of Research in Primary Care), SGLT2i (sodium-glucose cotransporter-2 inhibitors), WHO (World Health Organization)

      Keywords

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