Audit of clinical practice in the use of incretin mimetic agents for the management of patients with type 2 diabetes

Abstract

The objective of this audit was to compare treatment outcomes in patients on dipeptidyl peptidase (DPP)-4 inhibitors and glucagon-like peptide-1 receptor (GLP-1R) agonists within a hospital clinic setting, and to identify factors that might influence their response to treatment. We undertook a retrospective audit of 118 consecutive patients who received either a DPP-4 inhibitor or a GLP-1R agonist as add-on to existing oral hypoglycaemic agent therapy. Primary clinical outcomes compared were change in HbA1c and weight. The clinical characteristics of patients who responded with both weight loss and improvement in HbA1c were compared to those who did not. The results showed that more patients (73.6%) were on a GLP-1R agonist; 57% of patients on a GLP-1R agonist lost weight and had improved HbA1c compared to 40% of patients on a DPP-4 inhibitor. The mean reduction in HbA1c was 8.4mmol/mol with a mean weight loss of 2.6kg. There were good correlations between the initial HbA1c and decline in HbA1c in both treatment groups. In all, 68.3% of patients on additional insulin treatment improved HbA1c while 46.3% improved in terms of both weight and HbA1c. Patients not on insulin responded better to treatment (OR 1.96; p=0.047) with these agents. It was concluded that good metabolic control can be achieved if these agents are used judiciously. The DPP-4 inhibitors improve HbA1c but are weight neutral, while the GLP-1R agonists cause both weight loss and improvements in HbA1c. The addition of insulin under specialist supervision can be beneficial. COPYRIGHT © 2013 JOHN WILEY & SONS.