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. 2019 Sep 5;8(9):1389.
doi: 10.3390/jcm8091389.

Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes: Prescription According to Reimbursement Constraints and Guideline Recommendations in Catalonia

Josep Franch-Nadal  1   2   3 , Manel Mata-Cases  1   2   4 , Emilio Ortega  5   6 , Jordi Real  7   8 , Mònica Gratacòs  9 , Bogdan Vlacho  1 , Joan Antoni Vallés  10   11 , Dídac Mauricio  12   13   14
Affiliations

Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes: Prescription According to Reimbursement Constraints and Guideline Recommendations in Catalonia

Josep Franch-Nadal et al. J Clin Med. .

Abstract

To assess the clinical characteristics, the prescription pattern of GLP-1 receptor agonists (GLP-1RA) users, and HbA1c and weight change, we retrospectively assessed patients with type 2 diabetes by initiating GLP-1RA as an add-on to the standard of care in Catalonia. The mean change from the baseline in glycated hemoglobin (HbA1c) and weight at 6 and 12 months of therapy was calculated, and we assessed the predictors of the HbA1c reduction of ≥1% and/or the weight reduction of ≥3% as recommended by the Catalan Health Service. In 2854 patients who initiated a GLP-1RA during 2014 and 2015, the overall mean HbA1c values were reduced from the baseline by -0.84% (SD = 1.66) (-9.2 mmol/mol) and lost on average 2.73 kg (SD = 6.2). About 44% percent of patients decreased their HbA1c by ≥1%; 44% decreased their weight by ≥3%; and only 22% met both of them together. The odds of achieving a reduction of ≥1% in initial HbA1c were two-fold higher for patients with higher baseline levels, and the likelihood of a reduction of ≥3% in the initial weight was associated with a higher BMI at the baseline, but they were independent of each other. The composite outcome (_target 1% HbA1c reduction and 3% weight loss) to evaluate both the GLP-1RA clinical benefit and treatment withdrawal should be judged from a patient-centered approach.

Keywords: GLP-1 analogue; glycaemic control; observational study; primary care; type 2 diabetes mellitus.

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Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. M. M.-C. has received an advisory honorarium from Astra-Zeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi; he has received a speaker honorarium from Astra-Zeneca, Bayer, Boehringer Ingelheim, GSK, Lilly, Menarini, MSD, Novartis, Novo Nordisk, and Sanofi; he has received research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi. J. F.-N. has received advisory and or speaking fees from Astra-Zeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi; he has received research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi, and Boehringer. D.M. has received advisory and/or speaking fees from Astra-Zeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi; he has received research grants to the institution from Astra-Zeneca, GSK, Lilly, MSD, Novartis, Novo Nordisk, Sanofi, and Boehringer. E.O. has received advisory and or speaking fees from Astra-Zeneca, Boehringer Ingelheim, Lilly, MSD, Novo Nordisk, Sanofi, and Amgen; he has received research grants to the institution from MSD and Amgen. J.R., B.V., JA.V. and M.G. have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Proportion of patients achieving a beneficial outcome (i.e., HbA1c reduction ≥1% and/or weight reduction ≥3%) after six months of glucagonlike peptide-1 (GLP-1) receptor agonist initiation according to (A) the prescription label instructions (SmPC) and to (B) the health policy requirements for reimbursement. SmPC, summary of product characteristics; *** p < 0.0001.
Figure 2
Figure 2
Proportion of patients achieving a beneficial outcome after six months of glucagonlike peptide-1 (GLP-1) receptor agonist initiation according (A) to the baseline HbA1c level, and (B) to the baseline BMI level. *** p < 0.0001; ** p < 0.001; * p < 0.05.
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