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Treatment and Clinical Measures after Initiation of Injectable Therapy for Type 2 Diabetes—A Real-World Observational Cohort Study

Background: Injectable therapy is required when patients with type 2 diabetes (T2D) do not achieve glycemic control despite previous dietary and lifestyle modifications combined with oral antidiabetic therapy. While both Glucagon-like peptide-1 receptor agonists (GLP-1-RA) and insulin therapy are prescribed, real world evidence is lacking regarding relative therapeutic benefit. The objective of this study was to examine if there were changes in treatment and clinical measures in individuals who initiated any insulin vs. GLP-1 RA injectable therapy. Methods: All patients with T2D for at least five years who initiated any insulin or GLP-1 -RA therapy between 2010-2014 were identified in Clalit Health Services electronic medical records. Clinical measures and medication use at the time of therapy initiation (index-date) and one year post index date were examined and changes over the period were analyzed. Results: A total of 49,807 patients were identified: 41,049 received insulin and 8,758 GLP-1 RA. One year post index date, mean HbA1c (%) levels decreased in both groups (from 9.56 ± 2.22 to 8.24 ± 1.79 among insulin initiators and from 8.92 ± 1.43 to 7.96 ± 1.51 among GLP-1 RA initiators). Furthermore, 24.8% of GLP-1 RA initiators vs. 11.7% insulin initiators achieved >5% decrease in BMI level. There was a similar decrease in the percentage of patients purchasing oral hypoglycemic agents in both groups. No change was demonstrated in systolic and diastolic blood pressure between the 2 groups. Conclusions: This descriptive assessment found that clinical improvement was achieved in individuals that purchased insulin or GLP-1 RA, with a greater percentage achieving favorable HbA1c and BMI levels among those that initiated GLP-1 RA. Longer term follow-up with adjusted analyses is necessary in order to understand if the differential impact persists between these therapeutic treatments for individuals with T2D. Disclosure O. Reges: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. I. Gofer: None. X. He: None. T. Karpati: None. G. Rubin: Employee; Self; Eli Lilly and Company. M. Leibowitz: None. A. Strizek: None. B.S. Feldman: None.