1207-P: Early vs. Late Initiation of SGLT2 and GLP-1RA for Cardiometabolic Risk Factor Control: A Real-World Study
Authors: PAUL SANJOY KETAN , KOYE DIGSU , KHUNTI KAMLESH , MONTVIDA OLGA 
Published: June 2019

Aim: Benefits of early initiation of SGLT2 and GLP-1RA for glucose and cardiovascular (CV) risk factor control at population level real-world setting is not known. Association of early (≤ 6 months) vs. late (&gt;6 months) initiation of these drugs in the antidiabetic therapy management pathway on sustainable HbA1c, body weight, blood pressure and lipid control was evaluated.

Method: U.S. Centricity Electronic Medical Records of 21,897/28,266 pts with T2DM receiving SGLT2/GLP-1RA post 2013 without therapy overlap with min of 1 year follow-up was used. Odds of reducing CV risk factors within 6 month and maintaining the control over 1 year was estimated by timeline of these antidiabetes drug (ADD) initiation (first prescription date of SGLT2 or GLP-1RA - first prescription date of any first line ADD): HbA1c &lt; 7.5%, body weight reduction &gt; 5%, SBP &lt; 130/140 mmHg and LDL-C 70/100 mg/dL for patients with/without CVD history. Propensity score based balanced analyses were conducted.

Results: At SGLT2/GLP-1RA initiation, patients were 57/58 years old, mean HbA1c 8.7/8.8%, 79/76% had HbA1c ≥ 7.5%, body weight 102/107 Kg, 26/28% and 45/45% had uncontrolled SBP and LDL-C respectively, 22/22% had existing CVD, 80/78% and 84/86% were on lipid lowering and anti-hypertensive drugs respectively. Compared to late initiators, the early initiation of SGLT2/GLP-1RA was significantly associated with 47% (CI of OR: 1.27, 1.71)/23% (CI of OR: 1.07, 1.42) higher odds for longer term HbA1c control, and 58% (CI of OR: 1.31, 1.91)/52% (CI of OR: 1.28, 1.83) higher odds for at least two of the CV risk factors control simultaneously. The odds for risk factor control was similar for the two drugs, and similar for those with and without history of CVD.

Conclusion: This study based on large representative U.S. data suggests significant benefits of initiating SGLT2 or GLP-1RA early on the antidiabetes therapy management pathway for holistic glycaemic and cardiovascular risk factor control in patients with and without existing CVD.

Disclosure

S.K. Paul: Consultant; Self; AstraZeneca, Roche Pharma. Research Support; Self; Roche Pharma. D. Koye: None. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. O. Montvida: None.