Review of clinical use of glucagon-like peptide-1 in the management of type 2 diabetes

Within the last decade, multiple new medications have been licensed for treating type 2 diabetes. These agents are vastly more expensive than their predecessors and usage requires review in practice. This retrospective case series reviewed 55 patients to assess the effect of glucagon‐like peptide‐1 (GLP‐1) mimetics as add‐on to existing antidiabetic therapy, including insulin, in clinical practice. The primary outcome measures were change in HbA1c and weight. Analyses were also conducted to test the effect of: initial HbA1c; concomitant insulin use; GLP‐1 prescribed; and duration of diabetes on the change in HbA1c and weight. Mean BMI at initiation was 39.7 kg/m2; duration of diabetes at initiation 8.2 years; duration of GLP‐1 therapy at review 18.3 months. The mean changes in HbA1c (‑15.9 mmol/mol) and weight (‐5.5 kg) were both highly significant (p < 0.0001). NICE targets for HbA1c and weight reductions were met in 34.5%. Significant negative correlations were found between initial HbA1c and subsequent change in HbA1c (p = 0.0001) and between initial BMI and subsequent change in weight (p = 0.04), whereas a significant positive correlation was observed between initial HbA1c and subsequent change in weight (p = 0.01). No statistically significant changes in HbA1c or weight were observed in relation to: concomitant insulin use; GLP‐1 prescribed; or duration of diabetes. This study confirms GLP‐1 agents provide clinically useful reductions in HbA1c and weight. Further work is required to assess their effect if used earlier. A practical and pragmatic approach to assessment of the effectiveness of GLP‐1 has been proposed. Copyright © 2014 John Wiley & Sons, Ltd.