Introduction: Health care providers have many options for achieving glycemic control in individuals with T2D requiring treatment intensification. In this analysis from the PATHWAY study we address the question of optimal treatment choice, comparing intensification with additional oral antidiabetic drug (OAD), glucagon-like peptide-1 (GLP-1) analogs or insulin in individuals on 2 OADs.
Methods: Electronic medical records and claims data were from IBM MarketScan Explorys Claims-EMR (index period: 3/1/13-10/31/18). Inclusion required ≥1 claim for 2 different OADs in the 180 days pre-index, ≥1 claim for another OAD/GLP-1/insulin (day 0; index date), ≥1 HbA1c and weight measurement 180 days post-index (+/− 90 days), and ≥1 HbA1c and weight measurement close to index date (baseline). Cohorts for GLP-1s vs. OADs and vs. insulin were propensity score matched pairwise by baseline variables and exact matched by HbA1c category (Figure).
Results: Cohorts were well balanced across all baseline characteristics after matching. GLP-1 cohorts were significantly more likely to reach target HbA1c <7% and HbA1c <7% with no weight gain than either OADs or insulin (Figure).
Conclusions: Our results support clinical decision-making at treatment intensification, indicating that individuals on 2 OADs are more likely to achieve targets with GLP-1s than with further OAD or insulin.
C. Desouza: Consultant; Self; AstraZeneca, Bayer AG, Novo Nordisk A/S. A. Kirk: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. K.K. Mangla: Employee; Self; Novo Nordisk A/S. M.L. Wolden: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S.
Novo Nordisk A/S