{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T21:05:40Z","timestamp":1778879140756,"version":"3.51.4"},"reference-count":18,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Novo Nordisk A\/S","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2020,11,17]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Most patients with type 2 diabetes require sequential addition of glucose-lowering agents to maintain long-term glycemic control. In this retrospective, observational study, we compared intensification with a glucagon-like peptide-1 receptor agonist (GLP-1 RA), oral antidiabetic drugs (OADs), and insulin in patients receiving two OADs, using US electronic health records and claims data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>For inclusion, patients in the IBM MarketScan Explorys database were required to have claims for two different OADs in the 180-day baseline period and \u22651 claim for a different OAD\/GLP-1 RA\/insulin at index date (treatment intensification). Changes in glycated hemoglobin (HbA<jats:sub>1c<\/jats:sub>) and weight from baseline were assessed at 180 days postindex. Patients were propensity score-matched by baseline characteristics and exact-matched by HbA<jats:sub>1c<\/jats:sub> category (HbA<jats:sub>1c<\/jats:sub> cohort and weight\/composite outcomes cohort) and body mass index (BMI) category (weight\/composite outcomes cohort only) to obtain balanced treatment arms. The primary endpoint was the percentage of patients reaching target HbA<jats:sub>1c<\/jats:sub> &lt;7% (53 mmol\/mol).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Significantly more patients intensifying with a GLP-1 RA achieved HbA<jats:sub>1c<\/jats:sub> &lt;7% than those receiving OAD(s) (OR: 1.35; 95% CI 1.03 to 1.77; p=0.032) or insulin (OR: 1.77; 95% CI 1.27 to 2.47; p&lt;0.001). GLP-1 RAs were also associated with a significantly greater chance of not gaining weight; significantly greater HbA<jats:sub>1c<\/jats:sub> and weight decreases from baseline; and a significantly greater chance of HbA<jats:sub>1c<\/jats:sub> &lt;7%, no weight gain and discontinuation of \u22651 baseline OAD (composite outcome), compared with OAD(s) or insulin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In propensity score-matched cohorts, GLP-1 RAs demonstrated significant benefits for both glycemic control and weight management over additional OAD(s) or insulin, respectively, indicating that they may represent the optimal choice at these points in the treatment pathway.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2020-001830","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T11:55:16Z","timestamp":1609242916000},"page":"e001830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Real-world clinical outcomes following treatment intensification with GLP-1 RA, OADs or insulin in patients with type 2 diabetes on two oral agents (PATHWAY 2-OADs)"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-0568","authenticated-orcid":false,"given":"Cyrus","family":"Desouza","sequence":"first","affiliation":[{"name":"Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas R","family":"Kirk","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S, S\u00f8borg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal K","family":"Mangla","sequence":"additional","affiliation":[{"name":"Novo Nordisk Global Service Centre India Pvt. Ltd, Bangalore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L","family":"Wolden","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S, S\u00f8borg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7006-7401","authenticated-orcid":false,"given":"Ildiko","family":"Lingvay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"2025073111492357000_8.2.e001830.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0802987"},{"key":"2025073111492357000_8.2.e001830.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1003795"},{"key":"2025073111492357000_8.2.e001830.3","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-S008"},{"key":"2025073111492357000_8.2.e001830.4","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-S009"},{"key":"2025073111492357000_8.2.e001830.5","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1111\/dme.13900","article-title":"Intensification patterns and the probability of HbA1c goal attainment in Type 2 diabetes mellitus: real-world evidence for the concept of 'intensification inertia'","volume":"37","author":"Pantalone","year":"2020","journal-title":"Diabet Med"},{"key":"2025073111492357000_8.2.e001830.6","unstructured":"IBM . IBM Explorys cohort discovery, IBM Explorys therapeutic datasets, and IBM Explorys virtual workbench provide life sciences insights into real-world care delivery, 2016. Available: https:\/\/www-01.ibm.com\/common\/ssi\/ShowDoc.wss?docURL=\/common\/ssi\/rep_ca\/6\/872\/ENUSAP16-0346\/index.html&request_locale=en [Accessed 31 Jan 2020]."},{"key":"2025073111492357000_8.2.e001830.7","unstructured":"IBM Watson Health . White paper: IBM MarketScan research databases for life sciences researchers, 2018. Available: https:\/\/www.ibm.com\/downloads\/cas\/0NKLE57Y [Accessed 12 Feb 2020]."},{"key":"2025073111492357000_8.2.e001830.8","unstructured":"ICD . Codes. ICD-9-CM chapters, 2016. Available: https:\/\/icd.codes\/icd9cm [Accessed 5 Jun 2020]."},{"key":"2025073111492357000_8.2.e001830.9","unstructured":"ICD . Codes. ICD-10-CM chapters, 2016. Available: https:\/\/icd.codes\/icd10cm [Accessed 5 Jun 2020]."},{"key":"2025073111492357000_8.2.e001830.10","first-page":"449","article-title":"Estimating medication persistency using administrative claims data","volume":"11","author":"Sikka","year":"2005","journal-title":"Am J Manag Care"},{"key":"2025073111492357000_8.2.e001830.11","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"2025073111492357000_8.2.e001830.12","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1002\/pds.4325","article-title":"Comparison of the ability of double-robust estimators to correct bias in propensity score matching analysis. 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