Visual Abstract
Objective: Assess the efficacy of a GLP-1 agonist in patients with type 2 diabetes already on insulin therapy and identify factors that may predict a beneficial clinical response.
Methods: This is a retrospective analysis of patients with type 2 diabetes who have been treated with insulin and had a GLP-1 agonist (liraglutide, semaglutide or dulaglutide) added. Baseline, 3, 6 and 12 month data were collected.
Results: Eighty-one patients were included with a mean age of 61 years, BMI 34.4 ± 6.6 kg/m², duration of diabetes 16.9 ± 9.6 years, C-peptide 2.0 ± 1.1 ng/ml, HbA1C 8.2 ± 1.5% and daily insulin dose of 82.4 ± 72.3 units at baseline.
Among patients on prandial insulin at baseline, 46% had discontinued it by 1 year. In these patients mean baseline prandial dose (34.4 ± 15.7 units) was lower than that of patients who remained on prandial insulin (58 ± 41.2 units) at 1 year, but not significantly lower. There was no significant difference in change in HbA1C or percentage of patients who came off prandial insulin based on BMI (< or ≥30), insulin dose (< or ≥0.8 units per day) or duration of diabetes (< or ≥10 years).
Conclusion: In a cohort of patients with type 2 diabetes on insulin therapy the addition of a GLP-1 agonist reduced HbA1C, weight and insulin requirement. No significant predictor of response to GLP-1 agonists was identified when BMI, baseline insulin dose or diabetes duration were analyzed. Future analyses will include C-peptide as this database is expanded.
C. Gavigan: None. T. W. Donner: None.
