Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study

Abstract Aim We aimed to compare cardiovascular outcomes of patients with type 2 diabetes (T2D) who initiated GLP-1 receptor agonists (GLP-1RA) or basal insulin (BI) under routine care. Methods We accessed the administrative claims database of the Veneto Region (Italy) to identify new users of GLP-1...

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Autores principales:	Enrico Longato, Barbara Di Camillo, Giovanni Sparacino, Lara Tramontan, Angelo Avogaro, Gian Paolo Fadini
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Observational Real world Effectiveness Guidelines Pharmacotherapy Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/447b44f87db0441db24a3ed1de63dab6
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spelling	oai:doaj.org-article:447b44f87db0441db24a3ed1de63dab62021-11-14T12:15:53ZCardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study10.1186/s12933-021-01414-31475-2840https://doaj.org/article/447b44f87db0441db24a3ed1de63dab62021-11-01T00:00:00Zhttps://doi.org/10.1186/s12933-021-01414-3https://doaj.org/toc/1475-2840Abstract Aim We aimed to compare cardiovascular outcomes of patients with type 2 diabetes (T2D) who initiated GLP-1 receptor agonists (GLP-1RA) or basal insulin (BI) under routine care. Methods We accessed the administrative claims database of the Veneto Region (Italy) to identify new users of GLP-1RA or BI in 2014–2018. Propensity score matching (PSM) was implemented to obtain two cohorts of patients with superimposable characteristics. The primary endpoint was the 3-point major adverse cardiovascular events (3P-MACE). Secondary endpoints included 3P-MACE components, hospitalization for heart failure, revascularizations, and adverse events. Results From a background population of 5,242,201 citizens, 330,193 were identified as having diabetes. PSM produced two very well matched cohorts of 4063 patients each, who initiated GLP-1RA or BI after an average of 2.5 other diabetes drug classes. Patients were 63-year-old and only 15% had a baseline history of cardiovascular disease. During a median follow-up of 24 months in the intention-to-treat analysis, 3P-MACE occurred less frequently in the GLP-1RA cohort (HR versus BI 0.59; 95% CI 0.50–0.71; p < 0.001). All secondary cardiovascular endpoints were also significantly in favor of GLP-1RA. Results were confirmed in the as-treated approach and in several stratified analyses. According to the E-value, confounding by unmeasured variables were unlikely to entirely explain between-group differences in cardiovascular outcomes. Conclusions Patients with T2D who initiated a GLP-1RA experienced far better cardiovascular outcomes than did matched patients who initiated a BI in the same healthcare system. These finding supports prioritization of GLP-1RA as the first injectable regimen for the management of T2D.Enrico LongatoBarbara Di CamilloGiovanni SparacinoLara TramontanAngelo AvogaroGian Paolo FadiniBMCarticleObservationalReal worldEffectivenessGuidelinesPharmacotherapyDiseases of the circulatory (Cardiovascular) systemRC666-701ENCardiovascular Diabetology, Vol 20, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Observational Real world Effectiveness Guidelines Pharmacotherapy Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Observational Real world Effectiveness Guidelines Pharmacotherapy Diseases of the circulatory (Cardiovascular) system RC666-701 Enrico Longato Barbara Di Camillo Giovanni Sparacino Lara Tramontan Angelo Avogaro Gian Paolo Fadini Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
description	Abstract Aim We aimed to compare cardiovascular outcomes of patients with type 2 diabetes (T2D) who initiated GLP-1 receptor agonists (GLP-1RA) or basal insulin (BI) under routine care. Methods We accessed the administrative claims database of the Veneto Region (Italy) to identify new users of GLP-1RA or BI in 2014–2018. Propensity score matching (PSM) was implemented to obtain two cohorts of patients with superimposable characteristics. The primary endpoint was the 3-point major adverse cardiovascular events (3P-MACE). Secondary endpoints included 3P-MACE components, hospitalization for heart failure, revascularizations, and adverse events. Results From a background population of 5,242,201 citizens, 330,193 were identified as having diabetes. PSM produced two very well matched cohorts of 4063 patients each, who initiated GLP-1RA or BI after an average of 2.5 other diabetes drug classes. Patients were 63-year-old and only 15% had a baseline history of cardiovascular disease. During a median follow-up of 24 months in the intention-to-treat analysis, 3P-MACE occurred less frequently in the GLP-1RA cohort (HR versus BI 0.59; 95% CI 0.50–0.71; p < 0.001). All secondary cardiovascular endpoints were also significantly in favor of GLP-1RA. Results were confirmed in the as-treated approach and in several stratified analyses. According to the E-value, confounding by unmeasured variables were unlikely to entirely explain between-group differences in cardiovascular outcomes. Conclusions Patients with T2D who initiated a GLP-1RA experienced far better cardiovascular outcomes than did matched patients who initiated a BI in the same healthcare system. These finding supports prioritization of GLP-1RA as the first injectable regimen for the management of T2D.
format	article
author	Enrico Longato Barbara Di Camillo Giovanni Sparacino Lara Tramontan Angelo Avogaro Gian Paolo Fadini
author_facet	Enrico Longato Barbara Di Camillo Giovanni Sparacino Lara Tramontan Angelo Avogaro Gian Paolo Fadini
author_sort	Enrico Longato
title	Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
title_short	Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
title_full	Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
title_fullStr	Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
title_full_unstemmed	Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
title_sort	cardiovascular outcomes after initiating glp-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/447b44f87db0441db24a3ed1de63dab6
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Cardiovascular outcomes after initiating GLP-1 receptor agonist or basal insulin for the routine treatment of type 2 diabetes: a region-wide retrospective study

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