Glucagon-Like Peptide-1 Receptor Agonist Utilization in Type 2 Diabetes in Japan: A Retrospective Database Analysis (JDDM 57)

INTRODUCTION

There are limited real-world data on the prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes mellitus (T2DM).

METHODS

This was a retrospective analysis of the CoDiC® database of the Japan Diabetes Clinical Data Management Study Group (JDDM). Demographic and clinical characteristics, concomitant treatment patterns, and GLP-1 RA treatment persistence or modification in patients with T2DM initiating GLP-1 RA therapy were evaluated.

RESULTS

The analysis included 932 eligible patients with T2DM who had their first GLP-1 RA prescription (index date) between September 2016 and July 2018. Mean age was 63.8 years and 56.0% were male. Most patients had an index GLP-1 RA of dulaglutide (65.7%) or liraglutide (29.1%). Common comorbidities were obesity (58.7%), hypertension (54.7%), dyslipidemia (52.0%), retinopathy (11.3%), and nephropathy (10.2%). Mean hemoglobin A1c (HbA1c) levels decreased from 8.3 to 7.8% over 6 months after GLP-1 RA initiation, and the proportion of patients achieving HbA1c < 7.0% increased from 14.4% at index date to 22.9% at 6 months. Reductions occurred in mean body weight, body mass index, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and adjusted urinary albumin over 6 months. Antidiabetic medication use decreased after GLP-1 RA initiation, whereas non-antidiabetic medication prescribing showed little change. Index GLP-1 RA persistence rates were 80.5%, 66.2%, and 51.6% at 6, 12, and 18 months post-index, respectively, with a median persistence until discontinuation or switch of 600 days. Persistence rates at 6, 12, and 18 months post-index, respectively, were 81.9%, 70.7%, and 65.4% for dulaglutide and 79.7%, 60.0%, and 30.4% for liraglutide.

CONCLUSION

The study shows real-world benefits of GLP-1 RA therapy for T2DM, including improvements in HbA1c, body weight, and blood lipid profile, and supports the high rates of long-term persistence previously reported with dulaglutide, the GLP-1 RA most commonly prescribed for T2DM in Japanese clinical practice.

Long-term effectiveness of the Diabetes Conversation Map™ Program on health outcomes: A case-control retrospective cohort study

AIM

To evaluate the clinical and health behavioural outcomes of a large sample of participants from the Diabetes Conversation Map™ Program.

DESIGN

A matched-case-control study that was performed on a retrospective cohort study.

METHODS

Participants were 11,053 Clalit Health Services members with type 2 diabetes who enrolled in the Diabetes Conversation Map™ Program between January 2010 - April 2016. The matched-control group was formulated using sequential matching, by matching cases to controls at a ratio of 1:3, based on age, sex, and HbA1c level. The associations between the programme group and annual clinical and health behaviours were assessed between cases and controls at five time points using linear and Poisson regression analyses.

RESULTS

The intervention group had significantly lower HbA1c, glucose, and low-density lipoprotein levels and more frequent glucose blood testing each year up to 36 month post-enrolment compared with the matched controls. Other outcomes were significantly different for shorter time periods, including higher high-density lipoprotein and lower triglyceride levels at 6- and 12-month follow-up and lower diastolic blood pressure and greater medication adherence at 6-month follow-up.

CONCLUSIONS

Enrolment in the programme was associated with improved clinical and health behaviour outcomes for at least 6 months and most outcomes persisted for up to 36 months.

IMPACT

This is the first study to evaluate the Diabetes Conversation Map™ Program with a large sample over long period of time. This nurse-led group intervention evaluation adds to the literature on health outcomes on the lives of patients with type 2 diabetes.

STUDY REGISTRATION

This study was registered retrospectively to the Open Science Framework, the registration form can be found at: https://osf.io/63cse.

Patient-Reported Outcomes and Impact of Type 2 Diabetes: A Cross-Sectional Study in the Kingdom of Saudi Arabia

BACKGROUND

The Kingdom of Saudi Arabia (KSA) has the second highest prevalence of type 2 diabetes mellitus (T2DM) in the Middle East. There is a paucity of research on the experiences and treatment preferences of patients with T2DM in KSA. This study explored Saudi patients' health-related quality of life, eating habits, experiences during Ramadan, and preference between two glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment devices.

METHODS

A cross-sectional, observational study was conducted in three cities in KSA. Participants completed sociodemographic and clinical forms, EQ-5D-5L, Impact of Weight on Self-Perceptions, and a diabetes treatment survey. Participants also viewed instructional videos on GLP-1 RA injection devices and indicated their device preference.

RESULTS

Of the 310 participants, 53% were male. The mean age was 43 years (range: 30.0-75.0), duration since diabetes diagnosis was 6.3 years (range: 0.2-27.1), the most commonly reported last HbA1c level was between ≥7.1% and 8% (45%). The mean EQ-5D-5L index score was 0.90, with some participants reporting problems with pain/discomfort (34.5%) and usual activities (33.2%). Patients reported a low-to-moderate impact of weight on self-perception. In preparation for Ramadan, participants sought physician advice on diabetes management (37%) and/or increased checks of their blood glucose (37%). After watching the videos, 89% (n=277) of participants indicated a device preference, with significantly more preferring the dulaglutide device (n=186, 67%) over the semaglutide device (n=91, 33%) (p<0.0001).

CONCLUSION

This study indicates that T2DM has a significant social, emotional, and behavioral impact on the lives of patients in KSA.

Comparison of Characteristics Between Chinese Patients Taking Glucagon-like Peptide 1 Receptor Agonists and Insulin: A Cross-sectional Database Analysis

PURPOSE

In China, although insulin has been prescribed for decades, glucagon-like peptide 1 receptor agonists (GLP-1-RAs) have been available as an injectable treatment for patients with type 2 diabetes mellitus (T2DM) since 2009. GLP-1 RAs are listed as second-line treatment in the 2017 Chinese Guideline for patients with T2DM in whom prior oral antidiabetic therapy has failed. This study compares the baseline characteristics of Chinese patients with T2DM taking different prescriptions of first injectable therapy (GLP-1-RA or insulin).

METHODS

The IQVIA Patient Diary Study database, which captures data from a patient medical record-based physician online survey, was the data source used in this study. Cross-sectional patient data were collected from hospitals in 15 major Chinese cities from June 1, 2016, to June 30, 2018. Adults with T2DM commencing either GLP-1-RA or insulin use as their first injectable antidiabetic therapy were included. Baseline demographic and clinical characteristics were compared between the GLP-1-RA and insulin treatment groups, using t tests and χ² or Fisher exact tests.

FINDINGS

Overall, 563 patients using GLP-1-RAs and 2387 using insulin were identified. In general, patients using GLP-1-RA were younger (mean [SD], 49.6 [10.8] years vs 59.3 [10.9] years), had lower mean (SD) glycosylated hemoglobin levels (8.5% [1.2%] vs 9.6 [1.7%]), had lower mean (SD) fasting plasma glucose levels (9.0 [1.9] mmol/L vs 10.8 [2.6] mmol/L), higher mean (SD) body mass indexes (29.4 [3.9] kg/m² vs 24.6 [3.1] kg/m²), had higher comorbidity of obesity (75% vs 15%), had a higher occurrence of hyperlipidemia (63% vs 44%), and had lower occurrence of neuropathy (13% vs 34%) when compared with those using insulin (P < 0.0001 for all). The results of multivariate logistic regression model indicate that when controlling other variables in the multivariate logistic regression model, a higher fasting plasma glucose level and a longer diagnosis duration are associated with higher odds of insulin therapy commencement, but higher body mass index and some comorbidities, such as obesity and hyperlipidemia, are associated with higher odds of being a GLP-1-RA user.

IMPLICATIONS

Significant differences were identified between selected baseline characteristics of patients initiating GLP-1-RA and insulin therapy, suggesting that these medicines are more likely to be prescribed to different types of patients with T2DM in China. These findings may help to inform Chinese physicians regarding the characteristics of those patients with T2DM who are initiating treatment with a GLP-1-RA or insulin. Because the Patient Diary Study data were collected from hospitals in 15 major cities in China, one noteworthy limitation is that the results may not represent the overall treatment pattern in rural areas of China.

Which patients with Type 2 diabetes will have greater compliance to participation in the Diabetes Conversation Map™ program? A retrospective cohort study

AIM

To investigate the characteristics of participants in the Diabetes Conversation Map™ (Map™) program who had higher vs. lower compliance to the program, to determine if program tailoring and monitoring is needed among these groups.

METHODS

This was a retrospective cohort study of 8990 patients enrolled in the Map™ program (low compliance [attending 0-1 sessions, n = 2759] and high compliance [attending ≥2 sessions, n = 6231]). Socio-demographic, clinical, health behaviors, and healthcare utilization characteristics were extracted. Multivariable stepwise logistic regression was used as the analysis strategy.

RESULTS

Those who were of higher socio-economic status (OR = 1.567, 95%CI:1.317-1.865), who lived in urban area (OR = 1.501, 95%CI:1.254-1.798), with greater frequency of primary care visits (OR = 1.012, 95%CI:1.002-1.021), with medium (OR = 1.176, 95%CI:1.013-1.365) or high oral medication adherence (OR = 1.198, 95%CI:1.059-1.356), and with a greater frequency of blood glucose tests (OR = 1.102, 95%CI:1.033-1.175) had greater odds of being in the high compliance group. Conversely, those aged 35-44 (OR = 0.538, 95%CI:0.402-0.721) and 45-54 years (OR = 0.763, 95%CI:0.622-0.937), with longer Type 2 diabetes duration (OR = 0.980, 95%CI:0.967-0.993), with higher blood glucose levels (OR = 0.999, 95%CI:0.998-1.000), and current (OR = 0.659, 95%CI:0.569-0.762) or former smokers (OR = 0.831, 95%CI:0.737-0.938) had reduced odds for being in the higher compliance group.

CONCLUSIONS

Instructors in advance can target sub-groups to increase their attendance rates, and consequently improve their outcomes.

Characteristics, Treatment Patterns, and Economic Outcomes of Patients Initiating Injectable Medications for Management of Type 2 Diabetes Mellitus in Japan: Results from a Retrospective Claims Database Analysis

INTRODUCTION

This study's objective was to describe characteristics, treatment patterns, and economic outcomes of type 2 diabetes mellitus (T2DM) patients initiating injectable antidiabetic medications in Japan.

METHODS

Adults (≥ 18 years) with T2DM, ≥ 2 claims for injectable antidiabetics between 1 August 2011 and 31 July 2015 (first claim = index date), no evidence of type 1 diabetes mellitus, ≤ 1 claim for insulin, no claims for GLP-1RA before index, and continuous enrollment for 6 months before (baseline) and 12 months after index (follow-up) were selected from the Japan Medical Center Database. Patient characteristics and outcomes during the baseline and follow-up periods were described overall and by provider, using the proxy setting of index medication [hospital (including outpatient departments) for specialists; clinic for general practitioner (GP)].

RESULTS

Of the 2683 patients included (mean age: 50 years, 67% male), 1879 (70%) initiated injectable antidiabetics with specialists and 804 (30%) with GPs. The specialist cohort had a significantly greater comorbidity burden, but lower HbA1c levels during baseline, and was more likely to receive intensified treatment at index than the GP cohort. Almost 40% of patients (almost 30% of GP cohort) did not use antidiabetics during baseline; the remaining patients received oral medications, primarily from GPs. During follow-up, patients used the index medication for approximately 7 months. Independent of specialist vs. GP setting, patients received antidiabetics and medications for T2DM-related comorbidities and complications during the baseline and follow-up periods from the same provider, primarily GPs. The overall average healthcare costs were ¥350,404 during baseline and ¥1,856,727 during follow-up.

CONCLUSIONS

In Japan, most T2DM patients initiated injectable antidiabetics with specialists vs. GPs. There were considerable differences in characteristics of patients treated by specialists vs. GPs. After initiation, injectable antidiabetics were largely prescribed by GPs. Future research should evaluate the factors associated with different provider practices and communication channels between specialists and GPs to improve patient management.

FUNDING

Eli Lilly and Co.

The cost-effectiveness of dulaglutide versus insulin glargine for the treatment of type 2 diabetes mellitus in Japan

AIMS

Dulaglutide is a new once weekly glucagon-like peptide-1 (GLP-1) receptor agonist administered via a disposable auto-injection pen for the management of type 2 diabetes mellitus (T2DM). The objective of this study was to estimate the cost-effectiveness of dulaglutide vs insulin glargine for the management of T2DM from a Japanese healthcare perspective, in accordance with recently approved Japanese Cost-Effectiveness Guidelines.

METHODS

The IQVIA CORE Diabetes Model (version 9) was used to estimate the long-term costs and effects of treatment with dulaglutide and insulin glargine. Direct comparative data from the Araki 2015 trial (NCT01584232) was used to inform the analysis. Costs associated with treatment and complications were derived from Japanese sources wherever possible and inflated to 2015 Japanese Yen (JPY). Utilities were based upon a European systematic review of diabetes utilities and adjusted for use in a Japanese population. One-way and probabilistic sensitivity analyses (OWSA and PSA) were conducted on all inputs and key modeling assumptions.

RESULTS

Dulaglutide 0.75 mg was associated with higher quality-adjusted life years (QALYs), life years (LYs), and total costs, compared to insulin glargine, resulting in an incremental cost-effectiveness ratio (ICER) of 416,280 JPY/QALY gained. Treatment with dulaglutide increased the time alive and free from diabetes-related complications by 4 months. OWSA and PSA indicated that results were robust to plausible variations in input parameters and modeling assumptions.

LIMITATIONS

Key limitations of this study are similar to other cost-utility analyses of diabetes, including the extrapolation of short-term clinical trial data into lifelong durations. In addition, due to the lack of robust published Japanese data, some values were derived from non-Japanese sources.

CONCLUSIONS

This analysis suggests that dulaglutide 0.75 mg may be a cost-effective treatment alternative to insulin glargine for patients with T2DM in Japan.

Smoking history as a predictive factor of treatment response in advanced non-small-cell lung cancer: a systematic review

Recent trials in patients with advanced non-small-cell lung cancer (NSCLC) suggest that nonsmokers may benefit more from epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy than will smokers. The aim of this systematic review was to assess smoking history as a predictive factor for treatment outcomes in patients with NSCLC. Relevant published literature was identified through systematic searches of databases (MEDLINE, EMBASE, Cochrane Library), oncology and thoracic journals, and abstracts from major oncology conferences using prespecified criteria. Articles reporting treatment outcomes (overall survival [OS], progression-free survival [PFS], and/or response rate) in smoking history subgroups from randomized controlled trials of targeted therapy and/or chemotherapy were reviewed. Data from 30 trials (32 articles, 4 abstracts) were included. Of these, 23 trials tested first-line therapy. Treatment arms included EGFR TKIs (13 trials), EGFR monoclonal antibodies (2 trials), non-EGFR targeted treatments (9 trials), chemotherapy (27 trials), and placebo or best supportive care only (3 trials). Smoking history definitions and analyses of its effect on treatment outcomes varied widely. Only 11 trials reported testing for a treatment-by-smoking history interaction. The available evidence supports but does not confirm smoking history as a predictive factor for the response to TKIs, particularly in previously treated patients. The evidence does not support smoking history as a predictor of response to non-EGFR-targeted therapies or chemotherapy. Smoking history and its effect on treatment response are inadequately reported. More rigorous collection, analysis, and reporting may clarify whether smoking history is a predictor of treatment response in advanced NSCLC.