FRI639 Effect Of Early Initiation Of GLP-1 RAs On Weight Reduction Among People With Type 2 Diabetes
Authors: Chinthammit Chanadda , Mody Reema , Liu Dongju , Benneyworth Brian D , Vallarino Carlos 
Published: October 2023

Abstract
Disclosure: C. Chinthammit: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company. R. Mody: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company. D. Liu: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company. B.D. Benneyworth: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company. C. Vallarino: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company.
Early initiation of glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy is associated with improved glycemic outcomes among people with type 2 diabetes (T2D). However, there is limited real-world evidence suggesting a similar impact on weight reduction. This study examined the relationship between timing of initiation of a GLP-1 RA and magnitude of weight reduction. This retrospective cohort study used data from the Optum® de-identified Market Clarity database from April 1, 2014, to March 31, 2020. Adults with T2D who initiated GLP-1 RA treatment during the index period, April 1, 2016 - March 31, 2019, were included. Date of first prescription was defined as index date. Patients were required to have continuous enrollment ≥2 years pre-index and 1-year post-index; have ≥1 weight and BMI values during the 6-month baseline and 1-year post-index periods; baseline BMI ≥25 kg/m2, and ≥1 pre-index oral antihyperglycemic drug (OAD) claim. Timing of GLP-1 RA initiation was proxied by the number of classes of OADs (1 OAD, 2 OADs, 3+ OADs) prescribed in the pre-index period, with fewer OADs indicating initiation of GLP-1 RA earlier in disease progression. Outcomes included weight change from baseline to 6 and 12 months of follow-up and proportion of patients achieving ≥5% weight reduction after GLP-1 RA initiation. In order to control for confounding, multivariable analyses (MVA) used weights based on propensity scores to examine the relationship between timing of GLP-1 RA initiation and post-index weight outcomes. Of the 4,194 patients evaluated, 1,317 (31.4%), 1,480 (35.3%), and 1,397 (33.3%) were classified into the 1 OAD, 2 OAD, and 3+ OAD cohorts, respectively. Baseline characteristics were fairly uniform across the three cohorts, but the 1 OAD cohort had more females (59.5%) than 2 OAD (51.1%) and 3+ OAD (44.7%), and a higher mean baseline BMI (1 OAD: 38.7 kg/m2; 2 OAD: 37.4 kg/m2; 3+ OAD: 36.4 kg/m2; p&lt;0.0001). The 1 OAD cohort experienced a larger magnitude of weight reduction from baseline to 6 months (-3.0 kg) and 12 months (-3.1 kg) of follow-up vs 2 OAD (-2.4 kg and -2.7 kg) and 3+ OAD (-2.3 kg and -2.4 kg). The 1 OAD cohort had the largest proportion of patients who achieved ≥5% weight reduction at 6 months (24.9%) and 12 months of follow-up (25.5%) vs 2 OAD (19.7% and 22.1%) and 3+ OAD (21.4% and 20.6%). MVA showed that earlier GLP-1 RA initiation (1 OAD) was associated with greater weight reduction at 6 months (p=0.008) and 12 months (p=0.012) of follow-up compared to later initiation (3+ OAD). No significant differences in weight change were observed between the 2 OAD and 3+ OAD cohorts. This study showed that earlier initiators (1 OAD) of a GLP-1 RA experienced a larger magnitude of weight reduction than later initiators (3+ OADs). The research underscores the importance of further exploring the potential impact of early T2D treatment on weight reduction.
Presentation: Friday, June 16, 2023