Switching from Glucagon-Like Peptide-1 Receptor Agonists Therapy to Second Generation Basal Insulins-Comparative Effectiveness Analysis of Glargine 300 U/mL vs. Degludec 100 U/mL-The RESTORE-G Real-World Study

ADA recommends early use of GLP1-RA in T2DM. In patients treated with GLP1-RA and needing therapy intensification, the switch to insulin therapy is still a common approach. Compared to first generation basal insulins, second generation ones (2BI) provide similar or improved efficacy with better safety profile. Aim of this RESTORE-G sub-study was to perform a comparative effectiveness analysis of switching to Glargine 300 U/mL (Gla-300) vs. Degludec 100 U/mL (Deg-100) in patients on GLP1-RA therapy (±oral hypoglycemic agents) needing intensification. Table shows sample sizes, patients characteristics and propensity score (PS) adjusted effectiveness results. Statistically significant larger reductions of HbA1c and FBG were obtained with Gla-300 vs. Deg-100 after 6 months. No statistically significant between-group differences were documented in weight and 2BI dose changes. PS matching (sensitivity analysis) confirmed the larger effect of Gla-300 vs. Deg-100 on HbA1c reduction [estimated mean difference -0.55% (95%CI -1.02;-0.08); p=0.02]. Switch from GLP1-RA to 2BI is a valuable option and Gla-300 vs. Deg-100 is associated with larger HbA1c decrease. There is urgent need to reduce clinical inertia, witnessed by very high HbA1c levels at switch and suboptimal titration of 2BI. Disclosure R.Candido: None. A.Nicolucci: Board Member; AstraZeneca, Research Support; Novo Nordisk, Sanofi, Sobi, Shionogi & Co., Ltd., AlfaSigma, Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance. M.Larosa: None. M.Rossi: Research Support; Sanofi, Novo Nordisk, Shionogi & Co., Ltd., AlfaSigma. R.Napoli: Advisory Panel; Sanofi, Eli Lilly and Company, Novo Nordisk, Research Support; Novo Nordisk, AstraZeneca, Speaker's Bureau; Sanofi, Eli Lilly and Company, Novo Nordisk, AstraZeneca, MSD Life Science Foundation. Restore-g study group: n/a. Funding Sanofi