Sugar, Sugar: Evaluation of Insulin Requirements with Initiation of Glucagon-Like Peptide-1 Agonists and Sodium-Glucose Co-Transporter-2 Inhibitors
Recommended Citation
George J, Lobkovich A, Nardolillo J, Farhat NM, Kolander S, Thomas E. Sugar, Sugar: Evaluation of Insulin Requirements with Initiation of Glucagon-Like Peptide-1 Agonists and Sodium-Glucose Co-Transporter-2 Inhibitors. J Am Coll Clin Pharm 2021; 4(12):1675-1675.
Document Type
Conference Proceeding
Publication Date
10-19-2021
Publication Title
J Am Coll Clin Pharm
Abstract
Introduction: Glucagon-like peptide-1 agonists (GLP1a) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) are newer classes of agents used in the treatment of Type 2 Diabetes Mellitus (T2DM) and may provide additional cardiorenal benefits. While there is currently some evidence that insulin dose should be reduced upon initiation of these agents, there is little real-world guidance supporting specific dose adjustments. Research Question or Hypothesis: The purpose of the study is to describe the insulin adjustments made upon initiation of GLP1a and SGLT2i for T2DM patients in the ambulatory care setting. Study Design: Multi-center, retrospective, cohort study. Methods: Adults with T2DM initiated on a GLP1a or SGLT2i while on concomitant insulin therapy and managed by an ambulatory care pharmacist at time of initiation were included in the study. The primary endpoint measured the percent change in total insulin at different time points after initiation of agent. The secondary endpoints were discontinuation of sulfonylurea therapy at 6 months, frequency of HbA1c targets achieved (A1c <8%), change from baseline HbA1c, and adverse effect profile of the agents. Results: Of the 150 patients included, 123 were initiated on a GLP1a and 27 on a SGLT2i. After 6 months of therapy, GLP1a initiation resulted in an 18.4% decrease (p<0.001) in insulin dosages while SGLT2i had a 6.5% increase (p=0.95). Of patients initially on a sulfonylurea, it was discontinued in 8/17 patients (47.1%) who were initiated on GLP1a and 4/5 patients initiated (80%) on SGLT2i. HbA1c targets were achieved in 72.4% of patients with GLP1a and 59.3% with SGLT2i. Absolute change in HbA1c was-1.7% for GLP1a and-1.5% for SGLT2i. Hypoglycemia occurred in 21.1% and 11.1% of patients started on GLP1a and SGLT2i, respectively. Conclusion: GLP1a initiation provided a significant decrease in total insulin dose of 18% after 6 months, whereas total insulin requirements increased after SGLT2i initiation.
Volume
4
Issue
12
First Page
1675
Last Page
1675
