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Aims/hypothesis <p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a cornerstone in type 2 diabetes management. In this study we evaluated heterogeneity in body weight and glycaemic responses to the initiation of liraglutide, semaglutide or dulaglutide in real-world clinical practice.</p> Methods <p>Data from 4467 adults with type 2 diabetes in the Diabetes Patient Follow-up (DPV) registry were analysed, focusing on changes in HbA<sub>1c</sub> and body weight over 6 months following initiation of a GLP-1 RA. We categorised participants based on their response: HbA<sub>1c</sub> reduction only, weight loss only, both or neither. This analysis was part of the IMI-Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy (IMI-SOPHIA) project.</p> Results <p>At 6 months’ follow-up the median absolute HbA<sub>1c</sub> reduction was 5.3 mmol/mol (IQR 13.9, −1.0) (0.49% [1.27, −0.09]) and relative body weight reduction was 1.43% (4.26, 0). Only 14% of participants achieved meaningful reductions in both HbA<sub>1c</sub> (absolute reduction ≥5.5 mmol/mol [0.5%]) and body weight (relative reduction ≥5%). Men and those with a higher baseline HbA<sub>1c</sub> were more likely to show an HbA<sub>1c</sub> only response (36% of participants; both <i>p</i>&lt;0.001), while older individuals and those with a longer diabetes duration were more likely to experience a weight-only response (7% of participants; both <i>p</i>&lt;0.001). Higher baseline body weight and lower eGFR (both <i>p</i>&lt;0.05) correlated with greater weight reduction, whereas lower baseline HbA<sub>1c</sub> and longer diabetes duration were linked to smaller HbA<sub>1c</sub> reductions (both <i>p</i>&lt;0.001).</p> Conclusions/interpretation <p>There is significant heterogeneity in responses to GLP-1 RA therapy among individuals with type 2 diabetes in routine clinical practice. However, in our study a substantial proportion achieved a reduction in either body weight or HbA<sub>1c</sub>. Future studies should explore why some individuals achieve either weight loss or HbA<sub>1c</sub> reduction but not both.</p> Graphical Abstract <p></p>

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Heterogeneity in response to GLP-1 receptor agonists in type 2 diabetes in real-world clinical practice: insights from the DPV register – an IMI-SOPHIA study

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  • 出版模式：

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  • 发表日期：

    2025年5月22日

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  • Martin Heni,
  • Lisa Frühwald,
  • Wolfram Karges,
  • Michael Naudorf,
  • Kathrin Niemöller,
  • Frank Pagnia,
  • Jörg Reindel,
  • Jochen Seufert,
  • Gisa Ufer,
  • Christian Wagner,
  • Reinhard W. Holl,
  • Nicole Prinz

摘要

Aims/hypothesis

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a cornerstone in type 2 diabetes management. In this study we evaluated heterogeneity in body weight and glycaemic responses to the initiation of liraglutide, semaglutide or dulaglutide in real-world clinical practice.

Methods

Data from 4467 adults with type 2 diabetes in the Diabetes Patient Follow-up (DPV) registry were analysed, focusing on changes in HbA1c and body weight over 6 months following initiation of a GLP-1 RA. We categorised participants based on their response: HbA1c reduction only, weight loss only, both or neither. This analysis was part of the IMI-Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy (IMI-SOPHIA) project.

Results

At 6 months’ follow-up the median absolute HbA1c reduction was 5.3 mmol/mol (IQR 13.9, −1.0) (0.49% [1.27, −0.09]) and relative body weight reduction was 1.43% (4.26, 0). Only 14% of participants achieved meaningful reductions in both HbA1c (absolute reduction ≥5.5 mmol/mol [0.5%]) and body weight (relative reduction ≥5%). Men and those with a higher baseline HbA1c were more likely to show an HbA1c only response (36% of participants; both p<0.001), while older individuals and those with a longer diabetes duration were more likely to experience a weight-only response (7% of participants; both p<0.001). Higher baseline body weight and lower eGFR (both p<0.05) correlated with greater weight reduction, whereas lower baseline HbA1c and longer diabetes duration were linked to smaller HbA1c reductions (both p<0.001).

Conclusions/interpretation

There is significant heterogeneity in responses to GLP-1 RA therapy among individuals with type 2 diabetes in routine clinical practice. However, in our study a substantial proportion achieved a reduction in either body weight or HbA1c. Future studies should explore why some individuals achieve either weight loss or HbA1c reduction but not both.

Graphical Abstract