Reducing or Discontinuing Insulin or Sulfonylurea When Initiating a Glucagon-like Peptide-1 Agonist.

Background: Hypoglycemia and weight gain are well-known adverse effects of insulin and sulfonylureas in patients with type 2 diabetes. Glucagon-like peptide-1 (GLP-1) agonist monotherapy has a low incidence of hypoglycemia, but when combined with insulin or sulfonylureas, patients have higher rates of hypoglycemia.

Methods: The primary study outcome was to determine the percentage of patients with dose reductions or discontinuation of insulin or a sulfonylurea at baseline, 3, 6, and 12 months. Secondary outcomes included changes in hemoglobin A and body weight measured. This was a single-center, quality assurance, quality improvement, retrospective chart review of patients prescribed a GLP-1 agonist while on insulin and/or a sulfonylurea between January 1, 2019, and September 30, 2022, at a pharmacist-led patient aligned care team (PACT) clinic at the Wilkes-Barre Veterans Affairs Medical Center.

Results: This retrospective chart review included 136 patients. Throughout 12 months of following the pharmacist-led PACT clinic, 55 patients (57.3%) had ≥ 1 insulin dose reduction, 16 patients (29.6%) had ≥ 1 dose reduction of a sulfonylurea, 14 patients (14.6%) discontinued insulin, and 21 patients (38.9%) discontinued their sulfonylurea.

Conclusions: Patients taking insulin and/or sulfonylurea in combination with a GLP-1 agonist may require a dose reduction or discontinuation of the diabetic agents. Patients on both insulin and sulfonylurea may need closer monitoring due to the higher incidences of discontinuations compared with patients on only 1 of these agents. Dose reductions or discontinuations of these diabetic agents can promote positive patient outcomes, such as preventing hypoglycemia, minimizing weight gain, increasing weight loss, and reducing hemoglobin A.