BACKGROUND AND AIMS: Many guidelines tend to recommend a stepwise treatment approach that may be associated with uncontrolled HbA1c between steps. However, timely and durable glycemic control is a key goal of T2DM treatment. This study compared longitudinal HbA1c in patients with uncontrolled T2DM receiving combination treatment with GLP-1 and basel insulin (BI) initiated either sequentially or simultaneously.
MATERIALS AND METHODS: Patients with T2DM from 1/1/2007-12/31/2014 were identified in the GE Centricity database. Patients receiving combination GLP-1/BI were selected (initiation of combination GLP-1/BI termed index date). Patients were required to have 6 months pre- and 1 year post-index physician history and pre-index date HbA1c > 7%. Patients were classified as having simultaneous GLP-1/BI initiation if they started both medications within 14 days of each other, otherwise patients were considered sequesntial initiators. In addition, patients were required to receive combination treatment (i.e. overlapping prescription orders for both medications) for a minimum of 30 or the first 60 days of the post-index date period. HbA1c was compared from 6 months pre- to 1 year post-index date.
RESULTS: A total of 5,453 patients initiated BI first, 3,930 patients initiated GLP-1 first, and 1,823 patients initiated GLP-1/BI simultaneously. Patients were of similar age across all study cohorts (mean [SD] age 56.7 [11.8] years among BI first, 57.0 [10.7] among GLP-1 first, and 55.9 [11.8] years among simultaneous initiators). Baseline HbA1c was similar across all study cohorts (mean [SD] HbA1c 9.1 [1.6] among BI first, 9.1[1.6] among GLP-1 first, and 9.0 (1.7) among simultaneous initiators), and the change in HbA1c during 1 year follow-up was similar across cohorts (0.7 for both simultaneous initiators and BI first, 0.8 for GLP-1 first). Among the subgroup of patients with baseline HbA1c > 10.0 (N=1,1172 BI first, 882 GLP-1 first, and 378 simultaneous initiators), baseline HbA1c was similar(9.6 [2.2] among BI first, 9.3 [2.0] among GLP-1 first, and 9.1 [1.9] among simultaneous initiators), and simultaneous initiators had the largest decrease in HbA1c during follow-up (mean [SD] change in HbA1c was 2.3 [2.1] for simultaneous initiators, 1.8 [1.7] for GLP-1 first, and 2.0 [2.0] for BI first).
CONCLUSION: Patients with very high HbA1c (i.e. HbA1c > 10) were found to have the largest HbA1c decrease if they simultaneously initiated GLP-1 and BI, indicating that patients may benefit from simultaneous over stepwise treatment initiation.
