This real-world retrospective observational analysis was conducted using data from REACHnet, a U.S. regional electronic medical records (EMR) database. Glycemic outcomes after simultaneous or sequential initiation of basal insulin (BI) and a glucagon-like peptide-1 receptor agonist (GLP-1 RA) were evaluated in patients with T2D uncontrolled (A1C ≥7.0%) on oral antidiabetes drugs (OADs). Three patient cohorts were defined: simultaneous BI and GLP-1 RA initiation (Cohort 1; n=109); initiation of BI followed by a GLP-1 RA with a gap of ≤90 days (Cohort 2; n=301); and initiation of BI followed by a GLP-1 RA with a gap of >90 days (Cohort 3; n=459). Baseline mean A1C was very similar across the cohorts (10.3%, 10.3%, and 10.2% in Cohorts 1, 2, and 3, respectively), as were comorbidities including dyslipidemia, hypertension, and obesity. Mean A1C decreased in all 3 cohorts in the 12 months from the date of first BI injection. The greatest mean A1C reductions occurred within 6 months of simultaneous administration (Cohort 1: -2.18%), followed by addition of a GLP-1 RA within 90 days (Cohort 2: -1.77%) and after 90 days (Cohort 3: -1.24%).
Results at 12 months were Cohort 1: -1.66%; Cohort 2: -1.46%; and Cohort 3: -1.32%. Persistence (i.e., non-discontinuation of index treatments) at 12 months was 74.3%, 73.8%, and 80.0% in Cohorts 1, 2, and 3, respectively. Simultaneous initiation resulted in more patients achieving A1C <7.0% at 12 months (33.4%, 24.5%, and 20.9% in Cohorts 1, 2, and 3, respectively); data were statistically significant different between Cohorts 1 and 3 (p=0.0186), but not between Cohorts 1 and 2 or Cohorts 2 and 3.
In conclusion, this retrospective analysis of real-world EMR data in patients with T2D uncontrolled on OADs suggests that simultaneous initiation of BI and a GLP-1 RA resulted in significantly better glycemic control than sequential initiation with a gap of >90 days.
X.V. Peng: Employee; Self; Sanofi. Stock/Shareholder; Spouse/Partner; AbbVie Inc. Stock/Shareholder; Self; AbbVie Inc., Sanofi. R. Ayyagari: Consultant; Self; Sanofi US. Other Relationship; Self; Various pharmaceutical companies. R. Lubwama: Employee; Self; Merck & Co., Inc., Sanofi. M.J. Van Vleet: Employee; Self; Sanofi US. L. Shi: None. E.G. Price-Haywood: None. P. Hollander: Advisory Panel; Self; Novo Nordisk Inc. V. Fonseca: Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Abbott, Asahi Kasei Corporation, Novo Nordisk Inc., Sanofi US, Takeda Pharmaceutical Company Limited. Research Support; Self; Bayer US. Stock/Shareholder; Self; Amgen Inc., BRAVO4HEALTH, Mellitus Health.
Sanofi U.S.
