Combining GLP-1 Therapy with FreeStyle Libre Yields Superior Glycemic Control in Type 2 Diabetes Patients: Study

Glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy offers significant glycemic benefits for individuals with type 2 diabetes. However, the impact of combining GLP-1 RA therapy with FreeStyle Libre systems (FSL) has not been previously explored. To address this gap, Eugene E. Wright, Abbott, Sylmar, California, USA, and colleagues aimed to compare changes in hemoglobin A1c (HbA1c) levels between individuals receiving GLP-1 therapy alongside FSL (GLP-1+FSL) and those receiving GLP-1 therapy alone (GLP-1).

For this purpose, the researchers utilized Optum’s de-identified Market Clarity Data, a linked electronic health records (EHR)-claims database. The study included adults with T2D and HbA1c levels of 8% or higher who started their first GLP-1 RA medication between 2018 and 2022. Participants in the GLP-1+FSL group initiated their first FreeStyle Libre system within ±30 days of starting their first GLP-1 medication.

The cohorts were matched in a 1:5 ratio based on baseline insulin therapy, age, sex, baseline HbA1c, and the type of GLP-1 RA. Changes in HbA1c were then compared between unmatched and matched groups at the six-month mark.

The study led to the following findings:

• The study comprised 24,724 adults in the unmatched cohort, with 478 participants in the GLP-1+FSL group and 24,246 in the GLP-1 group. In the matched cohort, there were 478 GLP-1+FSL users and 2,390 GLP-1 users, with a mean age of 53.5 ± 11.8 years and 53.5 ± 11.3 years, respectively.
• The HbA1c levels were 10.25 ± 1.68% in the GLP-1+FSL group and 10.22 ± 1.69% in the GLP-1 group.
• The reduction in HbA1c was significantly greater in the GLP-1+FSL group compared to the GLP-1 group, with changes of −2.43% versus −1.73% in the unmatched cohort and −2.43% versus −2.06% in the matched cohort.
• Further analysis showed that the combination of GLP-1+FSL was associated with greater HbA1c reductions across various subgroups: in patients on intensive insulin therapy (−2.32% versus −1.50%), non-intensive insulin therapy (−2.50% versus −1.74%), and those not using insulin (−2.46% versus −1.78%).
• Among users of specific GLP-1 RAs, HbA1c reductions were also greater for semaglutide (−2.73% versus −1.92%) and dulaglutide (−2.45% versus −1.71%).

In the real-world, retrospective observational study, adults with suboptimally controlled type 2 diabetes who initiated GLP-1 RA therapy alongside FreeStyle Libre demonstrated greater improvements in HbA1c compared to those receiving GLP-1 RA therapy alone. This enhancement in glycemic control was observed across patients on intensive insulin therapy, non-intensive insulin therapy, and non-insulin medications. Additionally, there were significant HbA1c reductions in patients using either semaglutide or dulaglutide formulations of GLP-1 RA.

"These findings suggest that the combined use of continuous glucose monitoring (CGM) with GLP-1 therapy may provide an additive benefit, aiding patients in reaching their glycemic targets. To further validate these results and explore the relationship between CGM usage and improved outcomes with GLP-1 RA therapy, additional studies are warranted," the researchers concluded.

Reference:

Wright EE, Roberts GJ, Chuang JS, Nabutovsky Y, Virdi N, Miller E. Initiating GLP-1 Therapy in Combination with FreeStyle Libre Provides Greater Benefit Compared with GLP-1 Therapy Alone. Diabetes Technol Ther. 2024 Oct;26(10):754-762. doi: 10.1089/dia.2024.0015. Epub 2024 May 31. PMID: 38669474.