All-Cause Mortality and Health Care Resource Utilization in Patients with Type 1 Diabetes Treated with Glucagon-like Peptide 1 Receptor Agonists/Glucose-Dependent Insulinotropic Polypeptide

Abstract

Background:

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) with or without glucose-dependent insulinotropic polypeptide (GIP) are Food and Drug Administration approved for patients with type 2 diabetes (T2D) and weight loss and are increasingly being used off-label in patients with type 1 diabetes (T1D). We evaluated all-cause mortality and health care resource utilization (HCRU) among patients with T1D receiving GLP-1 RA or GLP-1 RA/GIP dual agonist over a 2-year period.

Methods:

Using the TriNetX database, we identified patients with T1D using ICD-10 codes, excluding those with T2D or sodium–glucose cotransporter-2 inhibitor use. Patients with T1D were divided into two cohorts of 4212 patients each based on whether or not they received a GLP-1 single/dual receptor agonist (comparison cohort vs. control cohort). We performed 1:1 propensity matching for demographics (age, sex, race), body mass index, hemoglobin A1c, and several comorbidities. Primary outcomes included all-cause mortality, HCRU, endoscopic procedures, and use of gastrointestinal prescriptions. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for all outcomes except all-cause mortality, for which Cox regression analysis was performed to obtain the hazard ratio (HR) over 2 years.

Results:

The cohorts were predominantly white and female. Compared to the control cohort, patients taking GLP-1 single/dual receptor agonists had lower rates of all-cause mortality (HR = 0.18, 95% CI: 0.11–0.30, P < 0.0001), all-cause hospitalizations (OR = 0.30, 95% CI: 0.20–0.45, P < 0.0001), emergency department (ED) visits (OR = 0.56, 95% CI: 0.43–0.71, P < 0.0001), endoscopy use (OR = 0.52, 95% CI: 0.38–0.70, P < 0.0001), laxative prescription (OR = 0.52, 95% CI: 0.43–0.63, P < 0.0001), and prokinetic prescription (OR = 0.74, 95% CI: 0.57–0.96, P = 0.0238). No significant differences were observed for diabetic ketoacidosis (P = 0.1030), antiemetic prescription (P = 0.2950), and hypoglycemia (P = 0.7474).

Discussion:

These findings suggest that use of GLP-1 RA/GIP analogs in patients with T1D was associated with significantly lower HCRU, including hospitalizations and ED visits, and reduced all-cause mortality. Further studies are warranted to confirm these observational findings.