Trend 2010–2018 in the clinical use of GLP-1 receptor agonists for the treatment of type 2 diabetes in routine clinical practice: an observational study from Northeast Italy
- 59 Downloads
Several GLP-1 receptor agonists (GLP-1RA) have become available for the treatment of type 2 diabetes (T2D), and evidence on their beneficial effects has evolved. We evaluated how the clinical phenotype of patients initiating GLP-1RA changed from 2010 to 2018.
This was a retrospective study conducted at six diabetes outpatient clinics in Northeast Italy. We collected data of T2D patients who initiated new GLP-1RA between 2010 and 2018. We recorded baseline characteristics, including demographics, anthropometrics, cardiovascular risk factors, glucose control, lipid profile, liver enzymes, renal function and concomitant medications. We recorded updated HbA1c and body weight at follow-up.
There were 83,116 T2D patients from a general population of ~ 1,380,000 inhabitants. Among 6167 cases of GLP-1RA initiation, 5408 were analyzed after excluding intra-class switchers. Prescription of GLP-1RA increased exponentially, and the change in the type of GLP-1RA reflected waves of their entering the market. From 2010 to 2018, there were significant increases in baseline age, diabetes duration and prevalence of male sex, of cardiovascular disease and of insulin users. Blood pressure and cholesterol levels decreased concomitantly with increasing use of medications for the control of cardiovascular risk. Baseline average HbA1c (8.3% [67 mmol/mol]) and BMI (34 kg/m2) and their improvement after GLP-1RA initiation did not change over time.
Despite the early positioning of GLP-1RA in T2D treatment algorithms, GLP-1RA have been prescribed in patients with progressively more advanced disease stage and especially in the presence of cardiovascular disease. Optimization of GLP-1RA use in routine clinical practice is still needed.
KeywordsPharmacoepidemiology Real-world Observational study Effectiveness
GPF contributed to study design, analysis and manuscript writing. VF, MR, NS, AL, AP and AA helped in study design, data collection and manuscript revision. FT and MDA contributed to data collection and manuscript revision. All authors read and approved the final version of the manuscript.
Supported by institutional grants from the University of Padova.
Compliance with ethical standards
Conflict of interest
GPF received grant support, lecture or advisory board fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Mundipharma, NovoNordisk, Sanofi, Genzyme, Abbott, Novartis, Merck Sharp and Dohme. VF served as consultant for NovoNordisk. MR received lecture and advisory board fees from AstraZeneca, Boehringer Ingelheim, Novonordisk and Sanofi-Aventis. NS received lecture or consultancy fees from AstraZeneca, Boehringer–Lilly, Novartis, NovoNordisk, Sanofi-Aventis, Takeda, Merck Sharp and Dohme, Abbott and research support from NovoNordisk. AL received grant support, lectures or advisory board fees from Novo Nordisk, Sanofi, Abbott and Eli Lilly. AA received research grants, lecture or advisory board fees from Merck Sharp and Dome, AstraZeneca, Novartis, Boehringer Ingelheim, Sanofi, Mediolanum, Janssen, Novo Nordisk. FT, AP and MDA declare no conflict of interest.
Ethical standard statement
The study protocol was approved by the local ethical committee of each participating center.
In agreement with National regulations retrospective studies and on data protection and privacy, no informed consent was collected because the database was anonymous.
- 16.Cosentino F, Grant PJ, Aboyans V et al (2019) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 34:3035–3087Google Scholar
- 18.Zelniker TA, Wiviott SD, Raz I et al (2019) Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation 139:2022–2031CrossRefGoogle Scholar