Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017
Time to third-line anti-diabetes therapy intensification in patients receiving second-line GLP-1 receptor agonist, DPP-4 inhibitor and Sulfonylurea: A real-world study. (#334)
Objective: The possible benefits of adding incretin-based anti-diabetes drugs (ADDs) as second-line therapy post metformin in terms of delaying the need for third-line therapy or insulin initiation, compared to older classes of ADDs, have not been evaluated at population level.
Aims: In patients with second-line sulfonylurea, DPP-4 inhibitor (DPP-4i) or GLP-1 receptor agonist (GLP-1RA), to explore the time to intensification with (1) any third-line ADD, and (2) insulin any time during follow-up.
Methods: From Centricity Electronic Medical Records of US, patients (1) diagnosed with T2DM from 2005; (2) aged 18-80 years; (3) initiated therapy with metformin; (4) intensified with sulfonylurea, DPP-4i or GLP-1RA; and with (5) follow-up from second-line ≥ 1year, were selected (n=207,362). Time to intensification with a third-line ADD and insulin were evaluated with Restricted Mean Survival Time analysis approach.
Results: In the study cohort, 149,109/ 46,822/ 11,431 patients chose second-line sulfonylurea/ DPP-4i/ GLP-1RA, at mean age of 60/ 58/ 53 years respectively. In these groups, the mean HbA1c at second-line intensification were 8.4/ 8.1/ 7.8 % respectively, with 48/ 41/ 32 % of patients having HbA1c above 8%. The mean (95% CI) time to third-line ADD intensification in sulfonylurea/ DPP-4i/ GLP-1RA groups were 3.9 (3.88, 3.93)/ 4.1 (4.07, 4.17)/ 4.2 (4.14, 4.32) years respectively (Table 1). Second-line sulfonylurea users intensified with insulin sooner [mean (95% CI): 6.3 (6.23, 6.28) years], compared to DPP-4i and GLP-1RA users with mean (95%CI) of 7.1 (7.09, 7.18) and 6.6 (6.49, 6.67) years respectively. The patterns of intensification with third-line therapy and insulin were similar among patients initiating second-line ADD prior to or after 2010.
Conclusion: Incretin based therapies were not found to delay the need for third-line therapy intensification with any ADD, compared to sulfonylurea. Patients receiving DPP-4i as second-line therapy initiated insulin significantly later than those with sulfonylurea.
