Understanding the Gap Between Efficacy in Randomized Controlled Trials and Effectiveness in Real-World Use of GLP-1 RA and DPP-4 Therapies in Patients With Type 2 Diabetes

• DOI: 10.2337/dc16-2725
• Publication Date: 2017-08-12T00:40:20Z
• Authors: Ginger S. Carls; Edward Tuttle; Ruo-Ding Tan; Johnny Huynh; John Yee; Steven V. Edelman; William H. Polonsky
• Keywords: Dipeptidyl peptidase-4 inhibitor

OBJECTIVE The objective of this study was to estimate and explain the gap between clinical efficacy real-world (RW) effectiveness type 2 diabetes medications. RESEARCH DESIGN AND METHODS This mixed-methods quasi-experimental used retrospective claims (Optum/Humedica) compare change in HbA1c RW patients with 12 months after starting a glucagon-like peptide 1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase 4 (DPP-4) inhibitor published findings from randomized controlled trials (RCTs) evaluating these drugs. Selected were similar RCT patients, regression analysis data adjust for differences poorly adherent why may differ. RESULTS initiating GLP-1 RA (n = 221) DPP-4 652) experienced smaller reductions RA: −0.52% [−6 mmol/mol], DPP-4: −0.51% mmol/mol])than reported RCTs (−1.30% [−14 mmol/mol] seven RCTs, n 2,600; −0.68% [−8 four 1,889). Baseline HbA1c, additional medications, adherence significant explanatory factors change. Modeled estimates (−1.04% [−12 −0.69% mmol/mol]) within RCTs’ range −0.84% −1.60% [−9 −18 −0.47% −0.90% [−5 −10 mmol/mol]). Poor medication accounted approximately three-fourths expected results (gap 0.51% [6 RA; 0.18% [3 DPP-4). CONCLUSIONS is primarily significantly less than efficacy, suggesting an urgent need effectively address among diabetes.