Real World Evidence of the Effectiveness on Glycaemic Control of Early Simultaneous vs Later Sequential Initiation of Basal Insulin and GLP‐1 Receptor Agonists

INTRODUCTION In people with type 2 diabetes (T2D) uncontrolled with either glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin, there is limited knowledge on the effect of the length of time to intensification with the other injectable therapy. METHODS This retrospective cohort study assessed the impact of the timing of initiating both basal insulin and GLP-1 RA therapies on reaching glycaemic targets (HbA1c <7 % and <8 %, and ≥1 % and ≥2 % HbA1c reduction) over 12 months in people with markedly uncontrolled T2D (HbA1c ≥9 %) on oral antihyperglycaemic drugs identified on the Optum Humedica database (electronic medical records; 01/01/2011 to 06/30/2017). Study cohorts were defined by the days between initiating each injectable: Cohort A ≤30 (simultaneous initiation) and B 31-90; C 91-180; D 181-270; E 271-360 days (sequential initiation). RESULTS Cohort A had the best glycaemic outcomes at 6 and 12 months for all four endpoints, followed by Cohort B. The likelihood of achieving HbA1c <7 % did not significantly differ between Cohorts A and B (hazard ratio [95% confidence interval]: 0.87 [0.76-1.01]); Cohorts C, D and E were significantly less likely to achieve HbA1c <7 % than Cohort A (0.62 [0.53-0.72]; 0.62 [0.53-0.72]; 0.63 [0.54-0.73]). CONCLUSIONS In people with uncontrolled T2D requiring treatment with GLP-1 RA and basal insulin, greater improvements in glycaemic control were observed when both therapies were initiated within close time proximity of one another (≤90 days) compared with initiation 91-360 days apart. This article is protected by copyright. All rights reserved.