Treatment intensification following glucagon‐like peptide‐1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE‐G real‐world study.

Napoli, Raffaele; Nicolucci, Antonio; Larosa, Monica; Rossi, Maria Chiara; Candido, Riccardo; Aragiusto, Concetta; Arca, Marcello; Anichini, Roberto; Brandoni, Gabriele; Cavalot, Franco; Citro, Giuseppe; Crazzolara, Dalia; D'Angelo, Paola; Del Buono, Andrea; De Riva, Carlo; Di Benedetto, Antonino; Di Cianni, Graziano; Di Mauro, Maurizio; Fazion, Stefano; Fiorentini, Paolo

Aim: To compare the effectiveness of different basal insulins (BI) prescribed as an add‐on to or switch from glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) therapy. Materials and Methods: Retrospective, real‐world data from electronic medical records of 32 Italian diabetes clinics were used, after propensity score adjustment, to compare effectiveness after 6 months of treatment with second‐ versus first‐generation BI (2BI vs. 1BI) or glargine 300 U/ml versus degludec 100 U/ml (Gla‐300 vs. Deg‐100), when added to (ADD‐ON) or in substitution of (SWITCH) GLP‐1 RA. Only comparisons, including a minimum of 100 patients per group, were performed to ensure adequate robustness of the analyses. Results: In the ADD‐ON cohort (N = 700), greater benefits of 2BI versus 1BI were found in glycated haemoglobin {HbA1c; estimated mean difference: −0.32% [95% confidence interval (CI) −0.62; −0.02]; p =.04} and fasting blood glucose [FBG; −20.73 mg/dl (95% CI −35.62; −5.84); p =.007]. In the SWITCH cohort (N = 2097), greater benefits of 2BI versus 1BI were found in HbA1c [−0.22% (95% CI −0.42; −0.02); p =.03], FBG [−10.15 mg/dl (95% CI −19.04; −1.26); p =.03], and body weight [−0.67 kg (95% CI −1.30; −0.04); p =.04]. In the SWITCH cohort starting 2BI (N = 688), marked differences in favour of Gla‐300 versus Deg‐100 were documented in HbA1c [−0.89% (95% CI −1.26; −0.52); p <.001] and FBG [−17.89 mg/dl (95% CI −32.45; −3.33); p =.02]. Using propensity score matching as a sensitivity analysis, the benefit on HbA1c was confirmed [−0.55% (95% CI –1.02; −0.08); p =.02]. BI titration was suboptimal in all examined cohorts. Conclusions: 2BI are a valuable option to intensify GLP‐1 RA therapy. Switching to Gla‐300 versus Deg‐100 was associated with greater HbA1c improvement.

TYPE 2 diabetes; INSULIN receptors; PROPENSITY score matching; ELECTRONIC health records; BLOOD sugar

Diabetes, Obesity & Metabolism, 2024, Vol 26, Issue 9, p3576

1462-8902

Academic Journal

10.1111/dom.15697