Treatment intensification following glucagon-like peptide-1 receptor agonist treatment in type 2 diabetes: The RESTORE-G real-world study. in Nutrition, metabolism, and cardiovascular diseases : NMCD / Nutr Metab Cardiovasc Dis. 2023 Nov;33(11):2294-2305. doi: 10.1016/j.numecd.2023.07.025. Epub 2023 J

2023
AOU Alessandria
ASL VCO
AOU San Luigi di Orbassano

Tipo pubblicazione

Journal Article

Autori/Collaboratori (5)Vedi tutti...

Rossi MC
CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
Napoli R
Department of Translational Medical Sciences, Unit of Internal Medicine and Diabetes, Federico II University School of Medicine and Institute of Experimental Endocrinology and Oncology, National Research Council, Napoli, Italy.
Larosa M
Medical Affairs, Sanofi S.r.l., Milan, Italy.

et alii...

Abstract

BACKGROUND AND AIMS: To assess intensification approaches with basal insulin (BI) following glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment in type 2 diabetes (T2D). METHODS AND RESULTS: Real-world data were collected in electronic medical records by 32 Italian diabetes clinics between 2011 and 2021. Primary endpoint was the proportion of insulin-naïve T2D patients treated with GLP-1 RA who initiated (add-on or switch) BI. Secondary endpoints were: treatment approaches, mean time to BI start, effectiveness and safety. Among 7,962 eligible patients, BI was prescribed to 3,164 (39.7%; 95%CI 38.7; 40.8): 67.6% switched to BI (22.1% also starting 1-3 injections of short-acting insulin), 22.7% added BI while maintaining GLP-1 RA, and 9.7% switched to a fixed-ratio combination of GLP-1 RA and BI (FRC). Median time since the first GLP-1 RA to BI/FRC prescription was 27.4 (IQ range 11.8-53.5) months. In this study 60.3% of patients did not start BI/FRC, among whom 15.2% intensified GLP-1 RA therapy with other oral agents. Effectiveness and safety were documented in all intensification approaches with BI/FRC, but HbA1c level at intensification time of ?9.0% and suboptimal BI titration suggested clinical inertia. Use of second generation BI and add-on to GLP-1 RA schemes increased over time and effectiveness improved. CONCLUSION: Clinical inertia should be overcome using innovative insulin options. Timely combination therapy of BI and GLP-1 RA is a valuable choice.

Accesso banca dati bibliografica

PMID : 37679243

DOI : 10.1016/j.numecd.2023.07.025

Keywords

Type 2 diabetes; Safety; Insulin naïve; GLP-1 receptor agonists; Fixed-ratio combination; Effectiveness; Basal insulin;