Characteristics of patients with type 2 diabetes mellitus newly treated with GLP-1 receptor agonists (CHADIG Study): a cross-sectional multicentre study in Spain

Ignacio Conget, Dídac Mauricio, Rafael Ortega, Bruno Detournay, CHADIG Study investigators, Teresa Muros, Carmen de la Cuesta, Miguel Ángel Mangas, Cristina Hernández Herrero, Paloma de Castro Hernandez, Fernando Gomez-Peralta, Manuel Miralles García, Encarna Martinez, Guillem Cuatrecasas, Eva Aguilera, Marga Gimenez, Irene Vinagre, Jordi Anglada, Manuel Pérez Maraver, Jose Maria Manzanares, Pablo Fernández Catalina, Diego Bellido, Alfonso Soto González, Felipe Casanueva, Lluis Masmiquel, Luis Alberto Gómez, Honorato García, Iñaqui Arguelles, Juan Garcia Puig, Miguel Angel Mangas-Cruz, Francisco Javier Escalada, Sonia Gaztambide, Antonio Hernández Mijares, Francisco Javier Ampudia-Blasco, Carlos Tréscoli, Juan Francisco Merino-Torres, Luis de Teresa Parreño, Ignacio Conget, Dídac Mauricio, Rafael Ortega, Bruno Detournay, CHADIG Study investigators, Teresa Muros, Carmen de la Cuesta, Miguel Ángel Mangas, Cristina Hernández Herrero, Paloma de Castro Hernandez, Fernando Gomez-Peralta, Manuel Miralles García, Encarna Martinez, Guillem Cuatrecasas, Eva Aguilera, Marga Gimenez, Irene Vinagre, Jordi Anglada, Manuel Pérez Maraver, Jose Maria Manzanares, Pablo Fernández Catalina, Diego Bellido, Alfonso Soto González, Felipe Casanueva, Lluis Masmiquel, Luis Alberto Gómez, Honorato García, Iñaqui Arguelles, Juan Garcia Puig, Miguel Angel Mangas-Cruz, Francisco Javier Escalada, Sonia Gaztambide, Antonio Hernández Mijares, Francisco Javier Ampudia-Blasco, Carlos Tréscoli, Juan Francisco Merino-Torres, Luis de Teresa Parreño

Abstract

Objective: Several glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1Ra) have been made recently available in Spain for type 2 diabetes mellitus (DM2) treatment. There are no published data on the clinical and sociodemographic profile of patients initiating treatment with GLP-1Ra in Spain. Our objective was to understand these patients' characteristics in a real-world clinical practice setting.

Design: Cross-sectional observational study.

Setting: Spanish specialist outpatient clinics.

Participants: 403 adults with DM2 initiating GLP-1Ra treatment were included.

Primary and secondary outcome measures: Sociodemographic and DM2-related clinical data, including treatment at and after GLP-1Ra initiation and comorbidities, were collected.

Results: Evaluable patients (n=403; 50.9% female) were included (July 2013 to March 2014) at 24 centres by 53 specialists (47 endocrinology, 6 internal medicine), with the following profile (value±SD): age (58.3±10.4 years), diabetes duration (9.9±7 years), body mass index (BMI; 36.2±5.5) and glycated haemoglobin (HbA1c; 8.4±1.4%); 14% had HbA1c≤7%. Previous antidiabetic treatment: 53.8% only oral antidiabetic drugs (OADs), 5.2% insulin and 40% insulin and OAD; of those receiving OAD, 35% single drug, 38.2% 2 drugs and 24% 3 drugs. Concomitant to GLP-1Ra, 55.3% were only on OAD, 36.2% on insulin and OAD, and 7.2% only on insulin. Of those receiving OAD, the GLP-1Ra was mainly associated with 1 drug (65%) or 2 drugs (31.8%). GLP-1Ra are frequently added to existing antidiabetic drugs, with dipeptidyl peptidase-4 inhibitors being the OAD most frequently switched (45% receiving 1 before starting GLP-1Ra, only 2.7% receiving it concomitantly).

Conclusions: In Spain, GLP-1Ra therapy is usually started in combination with OADs or OADs and insulin. These drugs are used in relatively young patients often not reaching therapeutic goals with other treatment combinations, roughly a decade after diagnosis and with a relatively high BMI. The latter could be explained by Spanish regional payers limiting reimbursed prescription to patients with a minimum BMI threshold (>30 in most regions, >35 in some).

Keywords: GLP-1 receptor agonists; Patients’ characteristics; Spain; Type 2 diabetes mellitus.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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Source: PubMed

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