PMID- 38353180
OWN - NLM
STAT- MEDLINE
DCOM- 20240215
LR  - 20240217
IS  - 2150-1327 (Electronic)
IS  - 2150-1319 (Print)
IS  - 2150-1319 (Linking)
VI  - 15
DP  - 2024 Jan-Dec
TI  - Impact of Initiating a GLP1 Agonist and/or SGLT2 Inhibitor Therapy on 
      De-Escalation and Discontinuation of Insulin and Diabetes Control When Managed by 
      an Interprofessional Collaborative Team.
PG  - 21501319241231398
LID - 10.1177/21501319241231398 [doi]
LID - 21501319241231398
AB  - BACKGROUND: An FQHC in Denver, Colorado developed and implemented an 
      interprofessional care model to collaboratively manage type 2 diabetes mellitus 
      (T2DM). Utilizing the 340B program, the team protocolized ADA Guidelines to 
      promote the early adoption of first-line medications, glucagon-like peptide1 
      receptor agonists (GLP1 RAs) and sodium-glucose cotransporter 2 inhibitors 
      (SGLT2is) to improve patient outcomes. OBJECTIVES: To assess the impact of 
      interprofessional collaborative management versus standard care on early 
      initiation of a SGLT2i and/or GLP1 RA as first-line therapies to enhance (1) 
      deprescribing of insulin, (2) reducing overbasalization of insulin through 
      insulin de-escalation, and (3) effectively lowering A1C levels in adult primary 
      care patients with T2DM. METHODS: This was a retrospective chart review of adult 
      patients with T2DM who were initiated on a GLP1 RA and/or a SGLT2i. To determine 
      the effects of initiating GLP1 RA and/or SGLT2i therapy on insulin usage and 
      glycemic control, the total daily dose (TDD) of insulin before initiation was 
      compared with the most recent TDD post-initiation to evaluate deprescribing. To 
      determine the impact on overbasalization, pre-initiation and post-initiation 
      insulin doses were evaluated. The effectiveness of GLP1 RA and/or SGLT2i in 
      lowering A1C levels was determined by comparing the A1C prior to initiation with 
      the A1C postinitiation. To evaluate the influence of interprofessional 
      collaborative care on insulin deprescribing, overbasalization, and diabetes 
      control, relevant measures were compared between patients receiving collaborative 
      care versus standard care. RESULTS: Of the 60 total patients treated with 
      insulin, 46.6% were deprescribed insulin, with a majority in the 
      interprofessional collaborative group (93.1%) compared to standard care (6.9%). A 
      total of 78.3% of patients benefited from a reduction in A1C following the 
      initiation of a GLP1 RA and/or SGLT2i. The greatest A1C reduction was -2.9% in 
      the group receiving metformin in addition to a GLP1 RA and a SGLT2i. Patients who 
      received interprofessional collaborative care had an average A1c reduction of 
      -2.9% compared to-1.1% with standard care. CONCLUSION: Most patients initially 
      overbasalized on insulin experienced a reduction in overbasalization after 
      initiating GLP1 RA and/or SGLT2i. There was a notable A1C reduction, 
      de-escalation, and deprescribing of insulin in patients receiving 
      interprofessional collaborative care.
FAU - Champion, Megan
AU  - Champion M
AD  - University of Colorado College of Nursing, Denver, CO, USA.
FAU - Wills Avila, Gabriel
AU  - Wills Avila G
AD  - University of Colorado College of Nursing, Denver, CO, USA.
FAU - Garcia, Angelica E
AU  - Garcia AE
AD  - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 
      Denver, CO, USA.
FAU - Alvarez Delgado, Faviola M
AU  - Alvarez Delgado FM
AD  - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 
      Denver, CO, USA.
FAU - Valdez, Connie A
AU  - Valdez CA
AUID- ORCID: 0000-0002-4963-3533
AD  - University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 
      Denver, CO, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Prim Care Community Health
JT  - Journal of primary care & community health
JID - 101518419
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Insulin)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Glycated Hemoglobin)
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - Insulin/therapeutic use
MH  - *Diabetes Mellitus, Type 2/drug therapy
MH  - Hypoglycemic Agents/therapeutic use
MH  - Retrospective Studies
MH  - Glycated Hemoglobin
PMC - PMC10868501
OTO - NOTNLM
OT  - Federally Qualified Health Center
OT  - GLP1 receptor agonists
OT  - SGLT2 inhibitors
OT  - collaborative drug therapy management
OT  - community health center
OT  - diabetes mellitus
OT  - insulin
OT  - primary care
COIS- Declaration of Conflicting InterestsThe author(s) declared no potential conflicts 
      of interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2024/02/14 06:43
MHDA- 2024/02/15 06:43
PMCR- 2024/02/14
CRDT- 2024/02/14 05:54
PHST- 2024/02/15 06:43 [medline]
PHST- 2024/02/14 06:43 [pubmed]
PHST- 2024/02/14 05:54 [entrez]
PHST- 2024/02/14 00:00 [pmc-release]
AID - 10.1177_21501319241231398 [pii]
AID - 10.1177/21501319241231398 [doi]
PST - ppublish
SO  - J Prim Care Community Health. 2024 Jan-Dec;15:21501319241231398. doi: 
      10.1177/21501319241231398.