(1053) Assessing Glycemic Control Pre and Post Initiation of a GLP-1 Receptor Agonist in Adults Living with Type 2 Diabetes at a Federally Qualified Health Center

Objectives: • The primary objective of this study is to assess glycemic control pre and post initiation of a glucagon-like peptide-1 receptor agonist (GLP-1 RA)
• Secondary objectives for this study include assessing what other diabetes medications patients take, assessing glycemic control in patients only on a GLP-1 RA compared to patients that take multiple medications for diabetes, assessing for appropriate and timely titration of GLP-1 RA and to quantify the intensification of care patients receive via clinical service touchpoints.

For many adults living with diabetes the recommended A1c goal per ADA guidelines is less than 7%.1 This goal can be reached through a combination of healthy lifestyle behaviors and pharmacologic therapy. In the 2023 ADA Standards of Care GLP-1 RAs are considered an option for primary therapy in type 2 diabetes for patients with atherosclerotic cardiovascular disease (ASCVD) or for patients that have risk indicators for an ASCVD event.1 GLP-1 RAs are also a second-line option for patients with chronic kidney disease.1 They have also moved up in priority due to their high to very high efficacy for glucose lowering and weight loss benefit.1 Providing cardiovascular benefits and weight loss in addition to glycemic control is what makes this class of medication highly desired. This study aims to assess the impact of GLP-1 RAs on glycemic control for patients at a FQHC.

1. ElSayed NA, Aleppo G, Aroda VR, et al. Pharmacologic approaches to glycemic treatment: standards of care in diabetes—2023. Diabetes Care. 2022;46(Supplement_1). doi:10.2337/dc23-s009

Methods: This is a single-center retrospective analysis of adults 18 years or older who have type 2 diabetes and utilize the pharmacy at a FQHC to fill an initial prescription for a GLP-1 RA. The timeframe of this study will be from September 1st, 2022, to September 30th, 2023. Prescription fill history for initial GLP-1 RA prescriptions from September 1st, 2022, through October 31st, 2022, will be utilized. The remaining months will be for post initiation follow-up. Data will be collected from the institution’s electronic health record. Patients will be excluded from the study if they are less than 18 years of age, pregnant, or do not have a diagnosis of type 2 diabetes. The date of the initial GLP-1 RA prescription will be collected along with the most recent A1c before the date of the prescription and any A1c readings dated after the initial prescription. Glycemic control will be assessed by change in A1c post initiation of a GLP-1 RA. Other information to be collected includes descriptive statistics, other active diabetes medications, dose of GLP-1 RA at time of post A1c, and number of other encounters from nutrition, PharmD visits, behavioral health, and the health builders’ program.

Results: It is hypothesized that patients on a GLP-1 RA will have a decrease in A1c between 0.8 and 1.6% if patients are titrated to maximum tolerated dose in a timely manner. It is expected that a majority of patients will be on other medications for diabetes and may experience a larger decrease in A1c depending on when the other medications were initiated in relation to the initiation of the GLP-1 RA. It is also suspected that patients with more clinical touchpoints will have a greater decrease in A1c compared to patients with less clinical touchpoints. This study may provide insight that supports the use of current services offered by the institution and help highlight and identify future areas of expansion that can benefit patients.

Conclusions: N/A