Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Mechanick J.I., Garber A.J., Grunberger G., Handelsman Y., Garvey W.T. Dysglycemia-Based Chronic Disease: An American Association of Clinical Endocrinologists Position Statement. Endocr. Pract. 2018;24:995–1011. doi: 10.4158/PS-2018-0139. - DOI - PubMed
    1. Fonseca V.A. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32:S151–S156. doi: 10.2337/dc09-S301. - DOI - PMC - PubMed
    1. Garber A.J., Abrahamson M.J., Barzilay J.I., Blonde L., Bloomgarden Z.T., Bush M.A., Dagogo-Jack S., DeFronzo R.A., Einhorn D., Fonseca V.A., et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm--2016 Executive Summary. Endocr. Pract. 2016;22:84–113. doi: 10.4158/EP151126.CS. - DOI - PubMed
    1. ADA (American Diabetes Association) 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42:S90–S102. doi: 10.2337/dc19-S009. - DOI - PubMed
    1. Davies M.J., D’Alessio D.A., Fradkin J., Kernan W.N., Mathieu C., Mingrone G., Rossing P., Tsapas A., Wexler D.J., Buse J.B. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care. 2018 doi: 10.2337/dci18-0033. - DOI - PMC - PubMed

LinkOut - more resources