title: Clinical and Patient-Related Variables Associated with Initiating GLP-1 Receptor Agonist Therapy in Type 2 Diabetes Patients in Primary Care in Germany.
abstract: OBJECTIVE
  To investigate real-world clinical and patient-related variables associated with initiating GLP-1 receptor agonist (GLP-1RA) treatment relative to initiation of other glucose-lowering therapies in type 2 diabetes (T2D) patients of primary care in Germany.
  
  
  METHODS
  Data for 938 T2D patients who started therapy with a GLP-1RA within 823 practices of primary care throughout Germany were retrospectively analyzed (Disease Analyser: 01/2011-03/2014). 5,197 T2D patients who initiated other non-GLP-1RA antidiabetic therapies were selected as controls. Multivariate logistic regression analyses were applied to identify factors associated with GLP-1RA initiation in primary care.
  
  
  RESULTS
  Mean age (SD) of GLP-1RA users was 57.8 (11.8) years (males: 55.5%) and the average BMI was 36.1 (6.7) kg/m2. 22.8% were in diabetologist care and 12.0% had private health insurance. In multivariate regression, choice of GLP-1RA therapy instead of a different glucose-lowering drug class was associated with obesity (odds ratio: 1.68; 95% CI: 1.34-2.10), private health insurance (2.42; 1.89-3.09), younger age (0.94; 0.93-0.95 per year), male sex (0.85; 0.73-0.99), diabetologist care (2.11; 1.73-2.57), and geographic practice location (East vs. West-Germany; 1.25; 1.05-1.49). Among co-medication, angiotensin II antagonists (increased) and non-steroidal antirheumatic agents (decreased) were related to GLP-1RA prescriptions (both p<0.001).
  
  
  CONCLUSIONS
  Consistent with German guidelines, GLP-1RA is mainly prescribed preferentially in T2D patients who are obese. GLP-1RA drugs were more frequently used than other options in privately health insured patients and in patients seeing a diabetologist.
authors.affiliation: AstraZeneca, Global Medicines Development, Mölndal, Sweden.
authors.forename: Qing
authors.initials: Q
authors.lastname: Qiao
authors.affiliation: AstraZeneca, Global Medicines Development, Gaithersburg, Maryland, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Grandy
authors.affiliation: IMS Health, Real World Evidence Solutions, London, United Kingdom.
authors.forename: Josh
authors.initials: J
authors.lastname: Hiller
authors.affiliation: IMS Health, Epidemiology, Frankfurt am Main, Germany.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D057911:Angiotensin Receptor Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007004:Hypoglycemic Agents; D000097789:Glucagon-Like Peptide-1 Receptor Agonists