About 1 in 10 Americans are estimated to have Type 2 diabetes (T2D). The ever-evolving landscape of T2D management demands continual adaptation to diverse therapeutic interventions. Through a 5-year retrospective cohort study, this research assesses therapy usage for people with T2D (PWT2) and the impact unique regimens have on clinical outcomes. From 2018 to 2023, 2,310 PWT2 on various therapy regimens were surveyed four times per year about their diabetes management. Therapy usage included insulin, GLP-1 agonists, SGLT-2 inhibitors, and continuous glucose monitoring (CGM). Key health outcomes assessed were clinically recommended HbA1c of ≤7 and obesity (BMI ≥30). Longitudinal analysis revealed notable shifts in therapy usage among PWT2. From 2018 to 2023, overall insulin usage decreased 3%, GLP-1 (16% to 33%) and SGLT-2 usage (10% to 20%) doubled, and CGM usage increased fourfold (4% to 15%). Notably, among patients on insulin, SGLT-2 usage exceeded GLP-1 usage, while among those not on insulin, GLP-1 usage increased at a higher rate than SGLT-2s. These shifts in therapy combinations had diverse impacts on health outcomes. PWT2 on insulin without any other therapy showed no significant reduction in HbA1c or BMI over the five years, but those on insulin and a GLP-1, SGLT-2, or both showed significant reduction in HbA1c (p<.01). Among insulin users, those on an SGLT-2 only were the only group who did not experience reductions in BMI. PWT2 not on insulin or any other therapy experienced significant increases in HbA1c over the five-year period (p<.01), though all PWT2 not on insulin were able to reduce BMI significantly (p<.05). Results show that PWT2 who take insulin alone experience sub-optimal health outcomes, compared to those who take a combination therapeutic approach. While lifestyle changes will help PWT2 not on insulin, a lack of other therapies may lead to increased HbA1c. These findings underscore the need for tailored approaches to optimize T2D management and patient outcomes.
A. Beltran: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. A. Zeng: Employee; dQ&A. Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. T. Bell: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health. R. Wood: Research Support; Abbott, Dexcom, Inc., Eli Lilly and Company, diaTribe, Insulet Corporation, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Ypsomed AG, Teladoc Health.
