Treatment Intensification Strategies and Metabolic Outcomes in Individuals With Type 2 Diabetes on GLP-1 RA Therapy
Authors' conclusion
Adding OADs or BI/FRCs to GLP-1 RAs are optimal intensification strategies to provide glycemic control while avoiding weight gain. Target achievement rates are poor in individuals switched to insulin therapy. Therapeutic inertia remains a critical issue in clinical practice.
Study context
- Population
- Patients with T2D on GLP-1 RAs (2010–2022) receiving a first therapeutic intensification, AMD Annals database
- Participants
- 37,198 intensified patients
- Exposure
- Intensification strategies after GLP-1 RA: Oral antihyperglycemic drugs (OADs) vs basal insulin (BI) vs switch to fixed ratio combinations (FRCs) vs switch to BB
- Outcome
- HbA1c and weight changes
- Follow-up
- 6 and 12 months
Main finding
As reported in the abstract
BI
−0.92
%
FRCs
−0.85
%
- BI or FRCs: greatest HbA1c reduction and weight neutrality
- P < 0.001
- OADs: higher target achievement (HbA1c < 7%) and persistent weight loss
- 36%
- BB: weight gain
- +2.9 kg; P < .001
- BB: lower target achievement (HbA1c < 7%)
- 16.8%
Observational data: associations, not effects.
Further findings
Baseline characteristics
- BI mainly added in those with higher HbA1c and longer diabetes
- 8.9%
- OADs mostly given; particularly in those with higher BMI, lower HbA1c, shorter disease duration
- Suboptimal insulin titration across all strategies
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Treatment Intensification Strategies and Metabolic Outcomes in Individuals With Type 2 Diabetes on GLP-1 RA Therapy. J Clin Endocrinol Metab. Published 9 April 2025. doi:10.
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