Prior head-to-head open label trials comparing selected GLP-1RA(s) versus basal insulin(s) did not evaluate cardiovascular outcomes. Using 2 large U.S. commercial claims databases (Optum and Truven MarketScan) from 01/2012 to 12/2017, we assessed the risk of a composite cardiovascular outcome (MI, stroke) and serious hypoglycemia defined by validated claims-based algorithms comparing 26,308 patients with type 2 diabetes (mean age 58, mean HbA1c 8.6%) with prior or concurrent metformin therapy newly initiating an injectable GLP-1RA or basal insulin (Table). We estimated pooled incidence rates, meta-analyzed hazard ratios and 95% CI adjusting for >140 baseline clinical characteristics, including HbA1c. Baseline clinical characteristics were well-balanced in the two groups after 1:1 propensity score matching. In an as-treated analysis, the median follow-up was 148 days. Compared to basal insulin, initiating a GLP-1RA was associated with a lower risk of MI or stroke (HR 0.68 [95% confident interval (CI), 0.51 to 0.90]) and lower risk of serious hypoglycemia (HR 0.38 [95% CI, 0.25 to 0.57]). These results support recent clinical treatment guidelines that recommend starting a GLP-1RA before basal insulin for patients with type 2 diabetes with inadequate glycemic control despite metformin.
J. Luo: Consultant; Self; Alosa Health. A. Pawar: None. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S. D.H. Kim: None. S.C. Kim: Research Support; Self; AbbVie Inc., Bristol-Myers Squibb. E. Patorno: Other Relationship; Self; Boehringer Ingelheim International GmbH.
Brigham and Women’s Hospital