Associate Professor Tayla Rose’s team investigates real-world impact of diabetes medications

A team of Husky faculty led by Associate Clinical Professor Tayla Rose worked to investigate the real-world impact of diabetes medications in terms of both cost and effectiveness. The resulting article, “Real World Impact on Monthly Glucose-Lowering Medication Cost, HbA1c, Weight, and Polytherapy After Initiating a GLP-1 Receptor Agonist,” was published in the Journal of the American Pharmacists Association in October 2019 and earned the 2021 Clinical Research Paper Award from the American Pharmacists Association (APhA). This award is “intended to promote and encourage high-quality clinical research or practice-based research in the clinical sciences by recognizing an original research article in this area which has been published in the Journal of the American Pharmacists Association.” Rose and her co-authors, Michelle Jacobs, Debra Reid, Carla Bouwmeester, Michael Conley, Borna Fatehi, Thomas Matta, and Judith Barr, were presented with the award at the APhA virtual conference held in March.

At the time of publication, this was the first known real-world retrospective, pre-post cohort study evaluating the monthly cost and clinical impact of glucose-lowering medication regimens before and after adding a glucagon-like-peptide-1 (GLP-1) receptor agonist in the setting of uncontrolled type 2 diabetes. GLP-1 receptor agonist injections have become more popular in recent years due to their clinical efficacy. Unfortunately, these medications can cost upwards of $800 per month, though the cost to an individual depends on insurance coverage.

The study conducted by Rose and her team specifically focused on the use of this newer class of medications in underserved patients with diabetes, many of whom were insured by MassHealth, the Massachusetts Medicaid program. People on the commonwealth-run plan pay roughly $3 per month for GLP-1 receptor agonists, but, as Rose stated, “these medications are often cost-prohibitive to patients who are uninsured or underinsured.” The article reports the cost to the patient as well as the healthcare system should be considered when deciding whether to add a GLP-1 receptor agonist to such a regimen.

The study was a challenging one. These weren’t patients who were living under controlled conditions like some clinical trials. Participants in this study were people who may be working multiple jobs and living complex lives. Many were living below the poverty level. There were many non-English speakers, adding to the challenges of providing effective care.

“We wanted to get a picture of people in the real world,” Rose said. “How are they using the medications? How effective are they? Could they potentially reduce the use of insulin?”
Rose observed if someone was injecting insulin three or four times every day, and there was a way to decrease those injections, it may be easier to manage their diabetes.

Her team completed a retrospective analysis of patients who received a GLP-1 receptor agonist injection. The team compared the patient’s diabetes control, weight, and how many pills and injections they were taking 6-12 months after starting a GLP-1 agonist compared to an index date prior to receiving the medication.

“We looked at the same metrics,” Rose said. “The cost (of the medication). The patient’s diabetes control and their weight. That’s how we measured the impact.”

Information was gathered during routine visits to the patients’ respective health centers and their medication-taking habits at home were not monitored. The team was not tracking fingerstick blood glucose but rather seeing how significantly their A1C shifted.
Rose felt the results mined from the data showed that GLP-1 agonists were effective, especially in “the most complex patients,” because of their complicated regimens consisting of multiple daily insulin injections. Many were able to decrease their insulin needs, reducing or eliminating the need for mealtime insulin. She also noted the the cost of GLP-1 receptor agonists didn’t seem to be a barrier in the study.

“An increase in the cost of the medication, for this specific population, it didn’t impact the treatment significantly because of their insurance coverage. The cost wasn’t prohibitive. Private insurance is where the major challenges are because of high co-pays. The cost is definitely a barrier. We grapple with that.”

The study acknowledged a small sample size, a lack of information regarding patients adherence to their regimen, and limited follow-up time. The latter prevented assessing the effects’ durability on micro-and macrovascular outcomes. These results provided the first real world evidence that GLP-1 receptor agonists can help to reduce the need for insulin, which could have a significant impact on clinical care of patients with diabetes.