Diabetes, obesity & metabolismNov 10, 2017

Delaying stronger treatment with a hormone-based drug in type 2 diabetes patients not controlled by basic insulin

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 5, 2026

Abstract

A total of 139 patients initiated early intensification with a GLP-1 receptor agonist () for type 2 diabetes (T2D).

Delayed intensification with a GLP-1 RA resulted in a smaller reduction in levels (-0.68%) compared to early intensification (-1.01%).
The rate of overall hypoglycaemia was numerically higher in the delayed intensification group (0.26 events/patient-years) than in the early group (0.06 events/patient-years).
Total healthcare costs increased by $5266 in the no intensification group, reduced by $560 in the early intensification group, and increased by $1943 in the delayed group.

Simplified

AIM: To evaluate the effect of delaying treatment intensification with a glucagon-like peptide-1 receptor agonist () on clinical and economic outcomes in patients with type 2 diabetes (T2D).

METHODS: We conducted a retrospective observational claims study using IMPACT (Impact National Managed Care Benchmark Database) in adult patients with T2D who initiated basal insulin between January 1, 2005 and December 31, 2012, with or without OADs, who remained uncontrolled (glycated haemoglobin [] ≥7.0%). Patients were categorized into 3 groups: early, delayed, and no intensification with a GLP-1 RA. We evaluated changes from baseline to follow-up at 12 months for HbA1c level, rate of hypoglycaemic events, and healthcare costs, and we assessed the association between baseline patient characteristics and subsequent treatment intensification.

RESULTS: A total of 139 patients (9.0% of 1552 eligible patients) met criteria for inclusion in the early intensification group, 588 patients (37.9%) met criteria for inclusion in the delayed intensification group, and 825 patients (53.2%) met criteria for inclusion in the no intensification group. Mean baseline HbA1c values were 9.16%, 9.07%, and 9.34%, respectively. At follow-up, delayed intensification was associated with significantly smaller decreases in HbA1c from baseline (-0.68%) compared with early intensification (-1.01%). Rates of overall hypoglycaemia were numerically greater in the delayed intensification group than in the early intensification group (0.26 vs 0.06 events/patient-years of exposure, respectively). Change in semi-annual total healthcare costs was greater in the no intensification group (+5266 USD) compared with the early intensification group (-560 USD) and the delayed intensification group (+1943 USD).

CONCLUSIONS: Timely addition of a GLP-1 RA to therapy for patients with T2D who were not adequately controlled with basal insulin is associated with better clinical and economic outcomes.

Key numbers

-0.68%

Reduction

Change in from baseline in the delayed group.

0.26 events/patient-years

Overall Hypoglycaemia Rate

Rate of hypoglycaemic events in the delayed intensification group.

+5266 USD

Healthcare Cost Change

Increase in semi-annual healthcare costs in the no intensification group.

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Delaying stronger treatment with a hormone-based drug in type 2 diabetes patients not controlled by basic insulin

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