Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medication that is highly effective at treating Type 2 diabetes (T2D) due to its glucose-lowering ability. Although people with T2D treated with basal insulin may use both GLP-1 RA and Freestyle Libre (FSL) glucose monitors, the impact of FSL utilization on glycemic outcomes in the presence of GLP-1 RAs has not been widely studied. We conducted a retrospective cohort study using linked databases of FSL glucose values and Inovalon Insights insurance claims. Patients were ≥18 yrs old, diagnosed with T2D, initiated FSL between November 2017 and March 2022, and treated with basal insulin and GLP-1 RAs. FSL use and GLP-1 RA adherence were calculated using proportion of days covered (PDC) over 12-months from the index date (date of FSL initiation). Consistent FSL and adherent GLP-1 RA use were defined as PDC ≥0.8. Glucose management indicator (GMI) and % time in range (TIR) were calculated at baseline, 6-, and 12-months post index, and change in glycemic metrics from baseline to 12-months were assessed using paired t tests. A total of 2141 individuals met the inclusion criteria. Among consistent FSL users (56%), GMI and TIR did not change significantly from baseline to 12-months. However, among inconsistent FSL users (44%), changes were statistically significant overall: GMI increased by 0.27% (p<0.001) and TIR decreased by 3.94% (p<0.001). Subgroup analysis showed that regardless of GLP-1 RA adherence, inconsistent FSL users still had statistically significant worsening in GMI (nonadherent: 0.30%, p<0.001; adherent: 0.22%, p=0.006) and TIR (nonadherent: -3.70%, p<0.001; adherent: -4.34%, p=0.001). This study shows that frequent use of FSL plays a pivotal role in glucose management among people with T2D treated with basal insulin and GLP-1 RAs, where consistent FSL use is associated with sustained glycemic control, and inconsistent FSL use is associated with worsened glycemic outcomes.

Disclosure

E. Huang: Employee; Abbott. K. Kao: Employee; Abbott. L. Brandner: Employee; Abbott. A. Bindal: Employee; Abbott.

© 2024 by the American Diabetes Association
2024
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