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Open AccessArticle

Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes: Prescription According to Reimbursement Constraints and Guideline Recommendations in Catalonia

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DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
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CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, 08028 Barcelona, Spain
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Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, 08930 Barcelona, Spain
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Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, 08036 Barcelona, Spain
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CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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Drug Area, Gerència d’Atenció Primaria, Institut Català de la Salut, 08028 Barcelona, Spain
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Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous Universtity of Barcelona, 08041 Barcelona, Spain
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(9), 1389; https://doi.org/10.3390/jcm8091389
Received: 26 July 2019 / Revised: 30 August 2019 / Accepted: 3 September 2019 / Published: 5 September 2019
(This article belongs to the Special Issue Type 2 Diabetes: Update on Pathophysiology and Treatment)
To assess the clinical characteristics, the prescription pattern of GLP-1 receptor agonists (GLP-1RA) users, and HbA1c and weight change, we retrospectively assessed patients with type 2 diabetes by initiating GLP-1RA as an add-on to the standard of care in Catalonia. The mean change from the baseline in glycated hemoglobin (HbA1c) and weight at 6 and 12 months of therapy was calculated, and we assessed the predictors of the HbA1c reduction of ≥1% and/or the weight reduction of ≥3% as recommended by the Catalan Health Service. In 2854 patients who initiated a GLP-1RA during 2014 and 2015, the overall mean HbA1c values were reduced from the baseline by −0.84% (SD = 1.66) (−9.2 mmol/mol) and lost on average 2.73 kg (SD = 6.2). About 44% percent of patients decreased their HbA1c by ≥1%; 44% decreased their weight by ≥3%; and only 22% met both of them together. The odds of achieving a reduction of ≥1% in initial HbA1c were two-fold higher for patients with higher baseline levels, and the likelihood of a reduction of ≥3% in the initial weight was associated with a higher BMI at the baseline, but they were independent of each other. The composite outcome (target 1% HbA1c reduction and 3% weight loss) to evaluate both the GLP-1RA clinical benefit and treatment withdrawal should be judged from a patient-centered approach. View Full-Text
Keywords: GLP-1 analogue; type 2 diabetes mellitus; primary care; observational study; glycaemic control GLP-1 analogue; type 2 diabetes mellitus; primary care; observational study; glycaemic control
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Franch-Nadal, J.; Mata-Cases, M.; Ortega, E.; Real, J.; Gratacòs, M.; Vlacho, B.; Vallés, J.A.; Mauricio, D. Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes: Prescription According to Reimbursement Constraints and Guideline Recommendations in Catalonia. J. Clin. Med. 2019, 8, 1389.

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