Effectiveness of adding glucagon-like peptide-1 receptor agonist on diabetes complications and mortality among basal insulin-treated people with type 2 diabetes: A real-world Korean study

AIMS: To compare the effectiveness of adding a glucagon-like peptide-1 receptor agonist (GLP-1RA) on composite of diabetes-related complications and mortality with that of adding short-acting insulin (SAI) or shifting to premixed insulin among basal insulin (BI)-treated individuals with type 2 diabetes mellitus (T2DM) in South Korea. METHODS: From the Health Insurance Review and Assessment Service database, individuals with T2DM who initiated BI treatment and had advanced their treatment regimen from July 1, 2012, to December 31, 2018. RESULTS: A total of 38,634 individuals with T2DM were included in this study. Compared to adding SAI to BI, adding GLP-1RA was associated with decreased risks of cardiovascular complications (hazard ratio 0.56; 95 % confidence interval 0.43-0.72), severe microvascular complications (0.30; 0.19-0.48), diabetes-related hospitalization (0.62; 0.53-0.73), and all-cause mortality (0.27; 0.13-0.57). Compared to switching to premixed insulin, adding GLP-1RA was also associated with lower risk of cardiovascular complications (0.65; 0.51-0.84), severe microvascular complications (0.36; 0.22-0.58), diabetes-related hospitalization (0.62; 0.53-0.73), and all-cause mortality (0.32; 0.15-0.67). CONCLUSIONS: In this real-world Korean study, adding GLP-1RA to BI reduced risks of diabetes complications and all-cause mortality than adding SAI or shifting to premixed insulin.