OBJECTIVES: Compare effectiveness of intensification with Gla-300 or first-generation BIs on glycemic outcomes, healthcare resource utilization (HCRU) and costs in adults with T2D receiving GLP-1 RA ± oral antihyperglycemic drugs (OADs).

METHODS: Retrospective, observational study using the US Optum Clinformatics® Data Mart Claims database (4/1/2015–12/30/2021). Insulin-naïve adults with T2D receiving once-weekly GLP-1 RA therapy who intensified treatment (index date) with Gla-300 or a first-generation BI (NPH, detemir, insulin glargine 100 U/mL), were propensity score matched, 1:2, by baseline demographic and clinical characteristics. Primary endpoint was noninferiority of HbA_1c reduction from baseline–6 months between treatments. Secondary endpoints including hypoglycemia, achievement of HbA_1c <7% and HbA_1c <7% without hypoglycemia, HCRU, and costs, were analyzed descriptively.

RESULTS: After matching, 605 people intensified with Gla-300 and 1210 with first-generation BIs; most were dulaglutide users, 58.3% and 60.5%, respectively. Mean time to intensification with insulin was less than 1 year after GLP-1 RA initiation (Gla-300, 295.8 days; first-generation BIs, 279.1 days). Mean HbA_1c at baseline was 9.1–9.2%. Noninferiority (primary endpoint) was achieved for mean HbA_1c reduction from baseline for Gla-300 (−0.96%) versus first-generation BIs (−1.02%; p=0.0003). Hypoglycemia event rates/100 person-years were 6.4 versus 12.3 (rate ratio 0.50) with Gla-300 and first-generation BIs, respectively. Similar proportions of Gla-300 and first-generation BI users achieved HbA_1c <7% (25% and 24%) and HbA­_1c <7% without hypoglycemia (24% and 23%). Diabetes-related hospitalization and emergency-room event rates/100 person-years were lower with Gla-300 (22.7 and 11.2) than first-generation BIs (27.6 and 13.4). Diabetes-related annual costs per person were lower with Gla-300 versus first-generation BIs by $1,272.35 for hospitalization and $2,074.83 for healthcare claims costs.

CONCLUSIONS: In this US real-world study of people with T2D receiving weekly GLP-1 RA ± OADs, intensification with Gla-300 was associated with similar HbA_1c reduction and low hypoglycemia rates, and lower HCRU versus first-generation BIs.