Data on therapeutic approaches after GLP1-RA treatment failure are scant. Intensification strategies include addition of basal insulin to GLP1-RA, as free or fixed-ratio combination, as well as the switch to insulin therapy alone. Aim of the study was to assess treatment intensification approaches after GLP1-RA treatment and their effectiveness and safety in the real-word setting. A retrospective, multicenter study, based on electronic medical records collected between January 2011 and September 2021 was conducted. Overall, data relative to 17.861 patients with at least 1 prescription of GLP1-RA were collected by 32 centers in Italy. Among them, 3.164 (17.7%) needed intensification and were treated according to the three main treatment approaches reported in table. Intensification occurred after a median of 27 months. Data showed clinical inertia during and after GLP1-RA treatment, as documented by high HbA1c levels at intensification and suboptimal basal insulin dosing in all cohorts. Effectiveness and safety were documented in all cohorts, but many patients did not reach the HbA1c target. Low rate of hypoglycemia was documented especially in patients initiating FRC (Table) .

In conclusion, in the years to come, advancing therapy with timely addition and adequate titration of new basal insulin analogues or FRC may contribute to overcome clinical inertia.


R. Candido: None. A. Nicolucci: Board Member; AstraZeneca, Research Support; Novo Nordisk, PIKDARE S. p. A., Sanofi, Shionogi & Co., Ltd., Swedish Orphan Biovitrum AB, Speaker’s Bureau; Eli Lilly and Company. M. Larosa: Employee; Sanofi. M. Rossi: Research Support; AlfaSigma, Novo Nordisk, Sanofi, Shionogi & Co., Ltd., SOBI. R. Napoli: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Sanofi, Speaker’s Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi. Restore-g study group: n/a.



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