Initiating GLP-1 Therapy in Combination with FreeStyle Libre Provides Greater Benefit Compared with GLP-1 Therapy Alone

• Published in: Diabetes technology & therapeutics Vol. 26; no. 10; pp. 754 - 762
• Main Authors: Wright, Eugene E, Roberts, Gregory J, Chuang, Joyce S, Nabutovsky, Yelena, Virdi, Naunihal, Miller, Eden
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc., publishers 01.10.2024
• Subjects: Adult; Aged; Blood Glucose - analysis; Blood Glucose - drug effects; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Drug Therapy, Combination; Exenatide - therapeutic use; Female; Glucagon-Like Peptide 1 - therapeutic use; Glucagon-Like Peptide-1 Receptor - agonists; Glycated Hemoglobin - analysis; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Insulin - administration & dosage; Insulin - therapeutic use; Male; Middle Aged; Original Articles; CGM; RWE; type 2 diabetes; GLP-1; continuous glucose monitoring; real-world studies
• ISSN: 1520-9156; 1557-8593
• DOI: 10.1089/dia.2024.0015

Background and Aim: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) therapy provides glycemic benefits to individuals with type 2 diabetes (T2D). However, the effects of GLP-1 RA therapy in combination with FreeStyle Libre systems (FSL) are unknown. This study aimed to compare changes in hemoglobin A1c (HbA1c) between people acquiring GLP-1 with FSL (GLP-1+FSL) versus GLP-1 without FSL (GLP-1). Methods: This real-world study used Optum’s de-identified Market Clarity Data, a linked electronic health records (EHR)-claims database, and included adults with T2D and HbA1c ≥8% who acquired their first GLP-1 RA medication between 2018 and 2022. GLP-1+FSL subjects acquired their first FSL within ±30 days of their first GLP-1 acquisition. Cohorts were matched 1:5 on baseline insulin therapy, age, sex, baseline HbA1c, and GLP-1 type. Paired changes in HbA1c were compared between unmatched and matched groups at 6 months. Results: The study included 24,724 adults in the unmatched cohort (GLP-1+FSL, n = 478; GLP-1, n = 24,246). The matched cohort included 478 GLP-1+FSL users and 2,390 GLP-1 users: mean age 53.5 ± 11.8 and 53.5 ± 11.3 years, HbA1c 10.25 ± 1.68% and 10.22 ± 1.69%, respectively. HbA1c reduction was greater in the GLP-1+FSL group compared with the GLP-1 group in the unmatched cohort (−2.43% vs. −1.73%, difference 0.70%, P < 0.001, respectively) and in the matched cohort (−2.43% vs. −2.06%, difference 0.37%, P < 0.001). GLP-1+FSL vs. GLP-1 treatment was associated with greater HbA1c reduction in the intensive insulin (−2.32% vs. −1.50%), nonintensive insulin (−2.50% vs. −1.74%), and noninsulin group (−2.46% vs. −1.78%), as well as in patients using semaglutide (−2.73% vs. −1.92%) and dulaglutide (−2.45% vs. −1.71%) GLP-1 RA, all P < 0.001. Conclusions: Adults with suboptimally controlled T2D, initiating GLP-1 RA with FreeStyle Libre, had greater improvement in HbA1c compared with those treated with GLP-1 RA only. These results suggest an additional glycemic benefit of FSL when used with a GLP-1 RA in T2D treatment.