Abstract 15190: Association of Initiating SGLT2i and GLP1Ra Therapeutics on Insulin Utilization and MACE Outcomes Among Patients With Diabetes in an Integrated Healthcare System
Viet T Le, Heidi T May, Tami L Bair, Stacey Knight, Benjamin D Horne, Kirk U Knowlton, Jeffrey L Anderson- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Nearly 10% of US adults diagnosed with diabetes (DM) begin using insulin within 1 year (yr) of the diagnosis. A third of all patients (pts) with DM experience an atherosclerotic cardiovascular (CV) event. SGLT2is and GLP1Ras, have been shown to reduce major adverse CV events (MACE). Meta-analyses show a reduction in insulin utilization when these medications are initiated individually or concurrently. This study evaluated the real-world impact on MACE and insulin usage among pts with DM initiating SGLT2is and GLP1Ras.
Methods: Intermountain pts (n=6,476) ≥18 years of age with ≥3 encounters and on insulin at time of initiation of SGLT2i, GLP1-RA, or combined therapy from January 1, 2012 to November 30, 2021 were studied. Pts were stratified by whether they stopped-insulin (st-in) within 90 days of having started SGLT2i, GLP1Ra, or both or continued-insulin (co-in). MACE was defined as death, MI, CVA, or HF hospitalization and was assessed at 1- and 3-yrs.
Results: Of 6,476 pts, 93.3% (n=6,039) st-in and 6.7% (n=437) co-in. St-in pts had less comorbidities, but were older (58.2 vs. 55.0 years), male (55% vs. 48.5%), weighed less (105.5 vs. 110.7 kg), and included fewer pts with DM I (18.5% vs 38.4%). Renal function and hemoglobin A1C were similar. Compared to co-in, pts with st-in were prescribed SGLT2i (30.0% vs 20.4%) or combination (SGLT2i/GLP1Ra) (16.2% vs 11.2%) more often. St-in vs co-in had a higher frequency of MACE, which persisted after adjustment by risk factors, comorbidities, and medications (Table).
Conclusion: In pts with DM on insulin, adding SGLT2i, GLP1Ra, or both led to a change in insulin utilization, with >90% of pts stopping insulin entirely. However, we observed an increase in 1-yr and 3-yr MACE for st-in vs co-in pts. This suggests a need for caution when initiating these medications in those already on insulin with regards to insulin management, including a decision to discontinue insulin. More data are needed to further understand our observations.