LONG-TERM TREATMENT OUTCOMES WITH GLUCAGON-LIKE-PEPTIDE-1 RECEPTOR AGONIST (GLP-1RA)

A REAL-LIFE STUDY AT HOSPITAL PUTRAJAYA

Abstract

INTRODUCTION
GLP-1 receptor agnosits (GLP-1RAs) are reputable for their weight loss and glucose lowering benefits from various clinical trials. However, the extent to which real-world patients with type 2 diabetes (T2D) continue to respond to GLP-1RAs in successive years has not been well characterized.

METHODOLOGY
We conducted a retrospective cohort study involving 64 patients with T2D initiated on GLP-1RAs spanning 2011 to 2022. We analysed their weight change, glycaemic control, rate of GLP-1RAs discontinuation and adverse effects.

RESULTS
The median age of our cohort was 56 years (SD=13.4). Fifty-two patients (81.3%) had T2D longer than 10 years. Fortytwo (65%) were on insulin therapy before the initiation of GLP-1RAs. At baseline, mean HbA1c was 8.5% (SD=1.6), with a mean body weight of 97.5 kg (SD=23.6). The largest HbA1c reduction (–0.52%, p=0.014) was observed during the first 24 months of treatment but plateaued thereafter. The odds of achieving a better HbA1c reduction was much higher in younger patients (p=0.009), T2D less than 10 years (p=0.016) and lower baseline HbA1c (p<0.001). Substantial weight loss was observed during the first year of treatment (–3.3 kg, p<0.001) and the effect persisted beyond 5 years. The proportion of patients continuing GLP-1RA was 62.5% (2 years), 36% (3 years), 15.6% (5 years) and 12.5% beyond 6 years. Twentyfour patients (37.5%) discontinued treatment after an average duration of 36 months, due to lack of clinically meaningful HbA1c and weight reduction. Six patients (9.4%) developed pronounced gastrointestinal side effects, and three necessitated treatment discontinuation. Only one patient was hospitalized for adverse cardiac event within the first year of treatment.

CONCLUSION
GLP-1RAs continue to deliver the real-world benefit of weight loss beyond 3 years; however, its glucose-lowering effect diminished after the first 2 years. A personalized approach remains crucial in managing T2D patients on long-term GLP1RA.