在联用 FreeStyle Libre 的情况下启动 GLP-1 疗法比单独使用 GLP-1 疗法带来更大的益处。
Initiating GLP-1 Therapy in Combination with FreeStyle Libre Provides Greater Benefit Compared with GLP-1 Therapy Alone.
机构信息
South Piedmont AHEC, Charlotte, North Carolina, USA.
Abbott, Sylmar, California, USA.
出版信息
Diabetes Technol Ther. 2024 Oct;26(10):754-762. doi: 10.1089/dia.2024.0015. Epub 2024 May 31.
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) therapy provides glycemic benefits to individuals with type 2 diabetes (T2D). However, the effects of GLP-1 RA therapy in combination with FreeStyle Libre systems (FSL) are unknown. This study aimed to compare changes in hemoglobin A1c (HbA1c) between people acquiring GLP-1 with FSL (GLP-1+FSL) versus GLP-1 without FSL (GLP-1). This real-world study used Optum's de-identified Market Clarity Data, a linked electronic health records (EHR)-claims database, and included adults with T2D and HbA1c ≥8% who acquired their first GLP-1 RA medication between 2018 and 2022. GLP-1+FSL subjects acquired their first FSL within ±30 days of their first GLP-1 acquisition. Cohorts were matched 1:5 on baseline insulin therapy, age, sex, baseline HbA1c, and GLP-1 type. Paired changes in HbA1c were compared between unmatched and matched groups at 6 months. The study included 24,724 adults in the unmatched cohort (GLP-1+FSL, = 478; GLP-1, = 24,246). The matched cohort included 478 GLP-1+FSL users and 2,390 GLP-1 users: mean age 53.5 ± 11.8 and 53.5 ± 11.3 years, HbA1c 10.25 ± 1.68% and 10.22 ± 1.69%, respectively. HbA1c reduction was greater in the GLP-1+FSL group compared with the GLP-1 group in the unmatched cohort (-2.43% vs. -1.73%, difference 0.70%, < 0.001, respectively) and in the matched cohort (-2.43% vs. -2.06%, difference 0.37%, < 0.001). GLP-1+FSL vs. GLP-1 treatment was associated with greater HbA1c reduction in the intensive insulin (-2.32% vs. -1.50%), nonintensive insulin (-2.50% vs. -1.74%), and noninsulin group (-2.46% vs. -1.78%), as well as in patients using semaglutide (-2.73% vs. -1.92%) and dulaglutide (-2.45% vs. -1.71%) GLP-1 RA, all < 0.001. Adults with suboptimally controlled T2D, initiating GLP-1 RA with FreeStyle Libre, had greater improvement in HbA1c compared with those treated with GLP-1 RA only. These results suggest an additional glycemic benefit of FSL when used with a GLP-1 RA in T2D treatment.
胰高血糖素样肽-1 受体激动剂（GLP-1 RA）治疗为 2 型糖尿病（T2D）患者提供了血糖益处。然而，GLP-1 RA 联合 FreeStyle Libre 系统（FSL）的治疗效果尚不清楚。本研究旨在比较接受 GLP-1 联合 FSL（GLP-1+FSL）治疗与不接受 FSL 治疗的 GLP-1（GLP-1）患者的血红蛋白 A1c（HbA1c）变化。本真实世界研究使用了 Optum 的去识别 Market Clarity Data，这是一个链接的电子健康记录（EHR）-索赔数据库，纳入了 2018 年至 2022 年期间首次接受 GLP-1 RA 药物治疗且 HbA1c≥8%的 T2D 成年人。GLP-1+FSL 患者在首次获得 GLP-1 的±30 天内首次获得 FSL。在基线胰岛素治疗、年龄、性别、基线 HbA1c 和 GLP-1 类型方面，对无匹配和匹配队列进行了 1:5 的匹配。在 6 个月时，比较了无匹配组和匹配组之间 HbA1c 的变化。本研究纳入了 24724 名未匹配队列的成年人（GLP-1+FSL，n=478；GLP-1，n=24246）。匹配队列包括 478 名 GLP-1+FSL 使用者和 2390 名 GLP-1 使用者：平均年龄为 53.5±11.8 岁和 53.5±11.3 岁，HbA1c 分别为 10.25±1.68%和 10.22±1.69%。与 GLP-1 组相比，GLP-1+FSL 组在未匹配队列（-2.43%对-1.73%，差异 0.70%，<0.001）和匹配队列（-2.43%对-2.06%，差异 0.37%，<0.001）中 HbA1c 降低更大。与 GLP-1 治疗相比，GLP-1+FSL 治疗与 HbA1c 降低相关，包括强化胰岛素（-2.32%对-1.50%）、非强化胰岛素（-2.50%对-1.74%）和非胰岛素治疗（-2.46%对-1.78%），以及使用司美格鲁肽（-2.73%对-1.92%）和度拉糖肽（-2.45%对-1.71%）的 GLP-1 RA 患者，所有差异均<0.001。接受 GLP-1 RA 联合 FSL 治疗的 T2D 患者血糖控制不理想，与仅接受 GLP-1 RA 治疗的患者相比，HbA1c 改善更大。这些结果表明，在 T2D 治疗中，FSL 联合 GLP-1 RA 治疗可能具有额外的血糖益处。
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