Adding rapid-acting insulin or GLP-1 receptor agonist to basal insulin: outcomes in a community setting

Abstract

To evaluate real-world outcomes in patients with type 2 diabetes mellitus (T2DM)receiving basal insulin, who initiate add-on therapy with a rapid-acting insulin (RAI) or aglucagon-like peptide 1 (GLP-1) receptor agonist.Data were extracted retrospectively from a U.S. health claims database. Adults withT2DM on basal insulin who added an RAI (basal+RAI) or GLP-1 receptor agonist (basal+GLP-1) were included. Propensity score matching (1 up to 3 ratio) was used to control for differencesin baseline demographics, clinical characteristics, and health resource utilization. Endpointsincluded prevalence of hypoglycemia, pancreatic events, all-cause and diabetes-relatedresource utilization, and costs at 1 year follow-up. Overall, 6,718 matched patients were included: 5,013 basal+RAI and 1,705basal+GLP1. Patients in both groups experienced a similar proportion of any hypoglycemicevent (P = .4079). Hypoglycemic events leading to hospitalization were higher in the basal+RAIcohort (2.7% vs. 1.8%; P = .0444). The basal+GLP-1 cohort experienced fewer all-cause(13.55% vs. 18.61%; P<.0001) and diabetes-related hospitalizations (11.79% vs. 15.68%;P<.0001). The basal+GLP-1 cohort had lower total all-cause health care costs ($18,413 vs.$20,821; P = .0002), but similar diabetes-related costs ($9,134 vs. $8,985; P<.0001) comparedwith the basal+RAI cohort. Add-on therapy with a GLP-1 receptor agonist in T2DM patients receiving basalinsulin was associated with fewer hospitalizations and lower total all-cause costs compared withadd-on therapy using a RAI, and could be considered an alternative to a RAI in certain patientswith T2DM, who do not achieve effective glycemic control with basal insulin.