Effect of Glucagon-Like Peptide-1 Deprescription Following Nutrition Therapy via Telemedicine on Glycemia and Body Weight among People with Type 2 Diabetes in a Real-World Setting: A Propensity Score Matched Cohort Study

Abstract

ABSTRACTIntroductionRecent clinical trials demonstrate that glucagon-like peptide-1 receptor agonists (GLP-1) elicit substantial reductions in glycemia and body weight in people with type 2 diabetes and obesity but must be continued indefinitely to maintain clinical improvements. Given the high cost and poor real-world persistence of GLP-1, an effective maintenance therapy that enables deprescription and sustained clinical improvements would be valuable. Thus, the purpose of this real-world study was to assess the effect of GLP-1 deprescription on glycemia and body weight following co-therapy with carbohydrate restricted nutrition therapy (CRNT) supported via telemedicine in a continuous remote care model among people with type 2 diabetes and excess body weight.Research Design and MethodsA retrospective, propensity score matched cohort study among patients with type 2 diabetes at a nationwide telemedicine clinic was conducted using medical record data. Patients in whom GLP-1 were deprescribed (DeRx; n=154) were matched 1:1 with patients in whom GLP-1 were continued (Rx) or never prescribed (NonGLP). Longitudinal and between matched cohort differences in HbA1c and weight were assessed at enrollment, deprescription/index date, and 6 and 12 months (m) post-deprescription/index date using a linear mixed effects model.ResultsHemoglobin A1c and body weight measured 6 and 12 months following deprescription/index date did not significantly differ between cohorts and improved at deprescription/index date and at follow up intervals compared to enrollment. HbA1c rose 6-and 12m post-deprescription/index in both DeRx and Rx and at 12m in NonGLP (p<0.001) but most patients maintained A1c<6.5%. No regression in body weight was observed with >70% maintaining ≥5% body weight loss 12m post-deprescription/index date.ConclusionsThese results demonstrate that CRNT in a continuous remote care model provides an effective GLP-1 step-off and maintenance therapy, allowing patients to discontinue GLP-1 while maintaining body weight loss and glycemia below therapeutic targets.KEY MESSAGESWhat is already known on this topicGlucagon-like peptide-1 receptor agonists (GLP-1) have demonstrated in clinical trials significant reductions in glycemia and body weight among patients with type 2 diabetes and obesity with rapid regression of clinical improvements upon discontinuation of the medication even with persistent caloric restriction and exercise counseling, suggesting the drug must be continued indefinitely.Cost and poor persistence of the GLP-1 therapy pose real-world challenges to maintaining improved health outcomes long-term, so therapies that enable deprescription and maintenance of clinical improvements are needed.What this study addsThis study assessed the potential for utilization of carbohydrate restricted nutrition therapy (CRNT) supported via telemedicine in a continuous remote care model as a GLP-1 step-off and subsequent maintenance therapy.HbA1c and body weight up to 12 months following GLP-1 deprescription did not differ from matched cohorts in whom GLP-1 were continued or never utilized in this real-world study.How this study might affect research, practice or policyThis study informs clinical practice, showing that the CRNT supported by continuous remote care provides an effective GLP-1 step-off therapy, enabling maintenance of improved glycemia and weight loss following GLP-1 deprescription and mitigating the need for lifetime, continuous use of the pharmaceutical.