Miller Eden, Chuang Joyce S, Roberts Gregory J, Nabutovsky Yelena, Virdi Naunihal, Wright Eugene E
Diabetes and Obesity Care LLC, Bend, OR, 97702, USA.
Abbott, Santa Clara, CA, USA.
Diabetes Ther. 2024 Sep;15(9):2027-2038. doi: 10.1007/s13300-024-01619-1. Epub 2024 Jul 15.
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.
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.
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).
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.
胰高血糖素样肽-1受体激动剂（GLP-1 RA）和持续葡萄糖监测（CGM）均可改善2型糖尿病（T2D）患者的血糖水平。然而，在GLP-1 RA治疗中加用CGM是否能进一步改善糖化血红蛋白（A1c）尚不清楚。我们评估了已接受GLP-1 RA治疗但血糖控制欠佳的成年T2D患者开始使用FreeStyle Libre（FSL）6个月后A1c水平的变化。
这项回顾性观察性研究使用了Optum的匿名市场透明度数据，这是一个关联的电子健康记录-医保报销数据库，以评估获取FSL后A1c的变化。纳入标准为T2D诊断、年龄≥18岁、基线A1c≥8%，且首次获取FSL的时间在2018年至2022年之间。患者在获取FSL之前必须接受GLP-1 RA治疗，且在获取FSL的90天内至少有一张GLP-1 RA处方。GLP-1 RA起始治疗定义为2017年起最早的GLP-1 RA处方。在首次获取FSL 6个月后评估A1c的配对变化。
研究队列包括1454例成年T2D患者（年龄55±10岁，52%为男性，38%接受强化胰岛素治疗，从GLP-1 RA起始治疗到获取FSL的中位时间为471天，基线A1c为9.8±1.5%）。获取FSL后，患者的A1c下降了1.5±1.9%（p<0.001）。基线A1c>10%的患者下降幅度最大（n=497，-2.7±2.2%，p<0.001）。在基于胰岛素治疗和GLP-1 RA制剂的亚组中观察到显著改善。在获取FSL>24个月前开始GLP-1 RA治疗的患者中，A1c也有改善（n=478；-1.3±1.7%，p<0.001）。
在一项针对成年T2D患者的大型真实世界研究中，那些先前接受GLP-1 RA治疗的患者在获取FSL后A1c有显著改善，无论GLP-1 RA治疗时长、GLP-1 RA制剂或胰岛素治疗类型如何。这些发现支持在接受GLP-1 RA治疗的成年T2D患者中使用FSL。
