Comparative Effectiveness of Glucagon-like Peptide-1 Receptor Agonists Versus Oral Agents for Insulin Discontinuation in Type 2 Diabetes : A Target Trial Emulation
Authors' conclusion
Among veterans with T2D receiving basal insulin therapy, addition of GLP-1RA did not increase the chances of stopping insulin therapy compared with SGLT-2i or DPP-4i therapy.
Study context
- Population
- Veterans with T2D receiving basal insulin who initiated a GLP-1 RA, SGLT2i or DPP-4i in 2020–2022, US Veterans Health Administration electronic health record (EHR) data; 63% ≥65 years, 93% male, 70% White, 48% hemoglobin A1c (HbA1c) ≥9%
- Participants
- 8,869 matched sets
- Comparison
- GLP-1 RA vs SGLT2i vs DPP-4i initiation added to basal insulin
- Outcome
- Insulin discontinuation: first gap in insulin prescription fills of ≥12 months
- Follow-up
- 3 years
Methodological detailsmatched sets
- Matched sets
Main finding
As reported in the abstract
Insulin discontinuation · 3 years
Risk ratio (95% CI)
GLP-1RAvs SGLT-2i
0.93(0.86–1.01)
GLP-1RAvs DPP-4i
0.98(0.87–1.09)
Further findings
Insulin discontinuation, modified per protocol analysis
- Results were not substantively different in a modified per protocol analysis
Insulin discontinuation in subgroups
- No subgroup showed a comparative advantage of GLP-1 RA over SGLT2i or DPP-4i
Original publication
Comparative Effectiveness of Glucagon-like Peptide-1 Receptor Agonists Versus Oral Agents for Insulin Discontinuation in Type 2 Diabetes : A Target Trial Emulation. Ann Intern Med. Published 14 July 2026. doi:10.
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