Thapa, S, Vora, D, Rioles, N, Tsai, S, Weinstock, R, Zupa, M, Haw, J.S, Pasquel, F, Idrees, T, Ebekozien, O. Diabetes

Introduction and Objective: Benefits of GLP-1 agonist (GLP-1) use in people with type 2 diabetes (PwT2D) are documented, but the impact of adding continuous glucose monitoring (CGM) to GLP-1 therapy on glycemic outcomes is not well studied.

Methods: We conducted a retrospective cohort study of electronic medical record data from 3 centers. Eligible patients were aged ≥18 years, had completed endocrinology/primary care visits between 2021-2024, and had HbA1c measured at 4 timepoints: 12 & 6 months before, and 6 & 12 months after starting GLP-1. Pre-post effects of GLP-1 on HbA1c were evaluated using paired t-tests and McNemar tests. GLP-1 users on CGM initiated ±2 months of GLP-1 (GLP-1+CGM; n=349) were compared to GLP-1 only users (propensity matched 1:3 ratio).

Results: We identified 4,110 GLP-1 users (GLP-1+CGM: n=349, mean age=60 years; GLP-1 only: n=3761, mean age=61 years) and 44,087 non-users. GLP-1 use led to reduction in mean HbA1c (7.7% to 7.1%, p < 0.001), increased proportion with HbA1c <7.0% (35% to 51%, p < 0.001), and decreased proportion with HbA1c >9.0% (14% to 6%, p < 0.001) 12 months after GLP-1 initiation. GLP-1+CGM users compared to GLP-1 only users had lower 12-month mean HbA1c (7.2% vs 7.4%, p=0.03) and a greater decrease in HbA1c from baseline to 12 months (-0.9 vs -0.4, difference-in-difference=0.5, p=0.001, Figure).

Conclusion: GLP-1 is associated with improved HbA1c outcomes in PwT2D; adding CGM further lowered HbA1c.

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