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. 2024 Sep;15(9):2027-2038.
doi: 10.1007/s13300-024-01619-1. Epub 2024 Jul 15.

Association of Changes in A1C Following Continuous Glucose Monitoring Acquisition in People with Sub-Optimally Treated Type 2 Diabetes Taking GLP-1 RA Therapy

Eden Miller  1 , Joyce S Chuang  2 , Gregory J Roberts  3 , Yelena Nabutovsky  2 , Naunihal Virdi  4 , Eugene E Wright Jr  5
Affiliations

Association of Changes in A1C Following Continuous Glucose Monitoring Acquisition in People with Sub-Optimally Treated Type 2 Diabetes Taking GLP-1 RA Therapy

Eden Miller et al. Diabetes Ther. 2024 Sep.

Abstract

Introduction: Both glucagon-like peptide-1 receptor agonists (GLP-1 RA) and continuous glucose monitoring (CGM) improve glycemia in patients with type 2 diabetes (T2D). However, it is unknown whether adding CGM to GLP-1 RA therapy further improves A1c. We evaluated changes in A1c levels 6 months after initiation of FreeStyle Libre (FSL) in adults with sub-optimally controlled T2D already on GLP-1 RA therapy.

Methods: This retrospective, observational study used Optum's de-identified Market Clarity Data, a linked electronic health record-claims database to assess changes in A1c after FSL acquisition. Inclusion criteria were T2D diagnosis, ≥ 18 years, baseline A1c ≥ 8%, with the first FSL acquisition between 2018 and 2022. Patients were required to be on GLP-1 RA prior to FSL with at least one GLP-1 RA prescription within 90 days of FSL acquisition. GLP-1 RA initiation was defined as the earliest GLP-1 RA prescription from 2017 onwards. Paired changes in A1c were assessed at 6 months after initial FSL acquisition.

Results: The study cohort included 1454 adults with T2D (age 55 ± 10 years, 52% male, 38% with intensive insulin therapy, median 471 days from GLP-1 RA initiation to FSL, and baseline A1c 9.8 ± 1.5%). After FSL acquisition, patients experienced an A1c decrease of 1.5 ± 1.9% (p < 0.001). Patients with a baseline A1c > 10% had the largest reduction (n = 497, - 2.7 ± 2.2%, p < 0.001). Significant improvements were observed in subgroups based on insulin therapy and GLP-1 RA formulation. Those initiating GLP-1 RA therapy > 24 months before FSL acquisition also showed improvements in A1c (n = 478; - 1.3 ± 1.7%, p < 0.001).

Conclusions: In a large, real-world study of adults with T2D, those on prior GLP-1 RA therapy experienced significant A1c improvements after acquiring FSL, irrespective of GLP-1 RA duration, GLP-1 RA formulation, or insulin therapy type. These findings support the use of FSL in adults with T2D treated with GLP-1 RA.

Keywords: Continuous glucose monitoring; Glucagon-like peptide-1 receptor agonists; Real-world evidence; Type 2 diabetes.

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Conflict of interest statement

Eden Miller received consulting fees from Abbott, Astra Zeneca, Novo Nordisk, Boehringer Ingelheim, Eli Lilly, Merck, Sanofi US, and acted as a speaker for Abbott, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. Eugene E. Wright received consulting fees from Abbott, Bayer, Boehringer Ingelheim, Eli Lilly, Sanofi US, and acted as a speaker for Abbott, Bayer, Boehringer Ingelheim and Eli Lilly. Joyce S. Chuang, Gregory J. Roberts, Yelena Nabutovsky, and Naunihal Virdi are employees and stockholders of Abbott.

Figures

Fig. 1
Fig. 1
Baseline and follow-up A1c measurements. T time in days
Fig. 2
Fig. 2
A Changes in A1c for the study cohort. Error bars denote the standard deviation and p < 0.001 for the paired change. B Proportion of individuals with good glycemic control at follow-up. CI confidence interval
Fig. 3
Fig. 3
Changes in A1c by insulin therapy. Error bars denote the standard deviation and p < 0.001 for all paired changes. CI confidence intervals
Fig. 4
Fig. 4
Changes in A1c by baseline A1c levels. Error bars denote the standard deviation and p < 0.001 for all paired changes. CI confidence intervals
Fig. 5
Fig. 5
Changes in A1c based on A GLP-1 RA duration and B GLP-1 RA formulation. Error bars denote the standard deviation and p < 0.001 for all paired changes. CI confidence intervals, GLP-1 RA glucagon-like peptide-1 receptor agonists
See this image and copyright information in PMC

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