title: Primary-care observational database study of the efficacy of GLP-1 receptor agonists and insulin in the UK.
abstract: OBJECTIVE
  We investigated use and efficacy of glucagon-like peptide-1 (GLP-1) receptor agonists in UK practice.
  
  
  METHODS
  People starting a GLP-1 receptor agonist (exenatide, liraglutide) or insulin (glargine, detemir, NPH) after a regimen of two or three oral glucose-lowering agents were identified from The Health Information Network observational primary care database (2007-2011). Mean change in HbA1c and body weight were compared at 1 year between cohorts, adjusting for baseline characteristics.
  
  
  RESULTS
  Baseline characteristics of GLP-1 receptor agonist (n = 1123) vs. insulin (n = 1842) users were HbA1c 78 vs. 84 mmol/mol (9.3 vs. 9.8%) and BMI 38.2 vs. 30.9 kg/m². The GLP-1 receptor agonist cohort was younger, had shorter diabetes duration and follow-up, less microvascular disease and heart failure, higher estimated glomerular filtration rate and more use of oral glucose-lowering agents. Lower HbA1c reduction on GLP-1 receptor agonist [7 vs. 13 mmol/mol (0.6 vs. 1.2%) (n = 366 vs. 892)] was not statistically significant [adjusted mean difference -1.4 (95% CI -4.1, 1.2) mmol/mol], except in the highest HbA1c quintile [>96 mmol/mol (>10.9%); adjusted mean difference -17.8 (-28.6, -7.0) mmol/mol]. GLP-1 receptor agonist users lost weight [-4.5 vs. +1.5 kg; adjusted mean difference 4.7 (3.7, 5.8) kg; n = 335 vs. 634]. A UK 6-month target reduction for GLP-1 receptor agonists of 11 mmol/mol (1.0%) HbA1c and 3% weight was reached by 24.9% of those continuing treatment.
  
  
  CONCLUSIONS
  Those starting GLP-1 receptor agonists are heavier with better glycaemic control than those starting basal insulin. Subsequently, they have improved weight change, with similar HbA1c reduction unless baseline HbA1c is very high. The UK 6-month GLP-1 receptor agonist target is usually not reached.
authors: Grimsdyke House, London, UK. gillian_hall@gchall.demon.co.uk
authors: G C
authors: GC
authors: Hall
authors: A D
authors: AD
authors: McMahon
authors: M-P
authors: MP
authors: Dain
authors: E
authors: E
authors: Wang
authors: P D
authors: PD
authors: Home
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D048909:Diabetes Complications / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D011307:Drug Prescriptions; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D000067757:Glucagon-Like Peptide-1 Receptor; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications* / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D018027:Receptors, Glucagon / Q000037:antagonists & inhibitors*; D006113:United Kingdom; D015431:Weight Loss / Q000187:drug effects
chemical_list: D000067757:Glucagon-Like Peptide-1 Receptor; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D018027:Receptors, Glucagon; C000593833:GLP1R protein, human; C517652:hemoglobin A1c protein, human