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Impact of Glucagon-Like Peptide 1 Agonist Deprescription in Type 2 Diabetes in a Real-World Setting: A Propensity Score Matched Cohort Study
Amy L. McKenzie & Shaminie J. Athinarayanan

Published: 29 February 2024

Abstract
Introduction
Glucagon-like peptide 1 receptor agonists (GLP-1) elicit substantial reductions in glycemia and body weight in people with type 2 diabetes (T2D) and obesity, but existing data suggest the therapy must be continued indefinitely to maintain clinical improvements. Given the high cost and poor real-world persistence of GLP-1, an effective therapy that enables deprescription with sustained clinical improvements would be beneficial. Thus, the purpose of this real-world study was to assess the effect of GLP-1 deprescription on glycemia and body weight following co-therapy with carbohydrate restricted nutrition therapy (CRNT) supported via telemedicine in a continuous remote care model.

Methods
A retrospective, propensity score matched cohort study among patients with T2D at a telemedicine clinic was conducted. Patients in whom GLP-1 were deprescribed (DeRx; n = 154) were matched 1:1 with patients in whom GLP-1 were continued (Rx). HbA1c and body weight at enrollment in clinic (pre-CRNT), at date of deprescription or index date (derx/ID), and at 6 and 12 months (m) post-derx/ID were utilized in this study.

Results
No regression in weight was observed following deprescription with > 70% maintaining ≥ 5% weight loss 12 m post-derx/ID. HbA1c rose 6 m and 12 m post-derx/ID in both DeRx and Rx cohorts, but most patients maintained HbA1c < 6.5%. HbA1c and body weight measured 6 m and 12 m following derx/ID did not significantly differ between cohorts and were improved at derx/ID and at follow-up intervals compared to pre-CRNT.

Conclusion
These results demonstrate the potential for an alternate therapy, such as CRNT supported via telemedicine, to enable maintenance of weight loss and glycemia below therapeutic targets following discontinuation of GLP-1 therapy.

DENVER--(BUSINESS WIRE)--Virta Health has released first-of-its-kind, peer-reviewed data demonstrating the company’s approach to personalized nutrition therapy results in sustained weight loss after the discontinuation of glucagon-like peptide-1 receptor agonists (GLP-1s), including Ozempic. Published today in Diabetes Therapy, the data demonstrates Virta is a powerful and sustainable off-ramp from GLP-1s.

“GLP-1 drugs are not a long-term or silver bullet solution to America’s obesity crisis. In addition to their numerous side effects, they can cost anywhere from $900 to $1,300 per month, and are only effective if taken continuously over a lifetime”

These outcomes stand in stark contrast to other real-world results of GLP-1 weight loss treatments. Discontinuing the medications has been shown to lead to rapid worsening of blood sugar and weight regain, even when accompanied by physical activity and calorie restriction. Additionally, as many as two out of three people on GLP-1s stop within a year and quickly regain the weight they lost, underscoring the need for an effective medication-free alternative and off-ramp from the medications to achieve sustainable results.

The study assessed weight loss in two groups of Virta members with type 2 diabetes: those for whom (a) GLP-1s were fully deprescribed and (b) GLP-1s were continued. At one year follow-up, both groups achieved significant and sustained improvement in weight loss, with no differences between the groups. For those eliminating GLP-1 use, there was no change or regain in body weight, a result previously unheard of.

Virta’s prior clinical trials and real-world outcomes showed significant and sustained weight loss through a medication-free approach, demonstrating members who never started on GLP-1s were able to achieve and sustain similar weight loss to those who received GLP-1 therapy. These results, combined with today’s findings in Diabetes Therapy, demonstrate the company’s approach to personalized nutrition therapy serves as both a powerful alternative to and off-ramp from GLP-1s.

“GLP-1 drugs are not a long-term or silver bullet solution to America’s obesity crisis. In addition to their numerous side effects, they can cost anywhere from $900 to $1,300 per month, and are only effective if taken continuously over a lifetime,” said Sami Inkinen, co-founder and CEO of Virta Health. “Many companies claim their solutions can be used to maintain weight loss, but Virta is the first and only to provide data proving we can deliver drug-like impact without the drugs, and through provider-led personalized nutrition. Our approach – which is built on a decade of experience working with and without GLP-1’s to reverse type 2 diabetes – enables members to lose weight sustainably and maintain their results."

In line with these new findings, Virta announced the expansion of its Sustainable Weight Loss solution, a comprehensive approach to weight loss that enables employers and payers to offer responsible and individualized use of GLP-1s. The new features will include personalized journeys, providing members with safe and responsible access to the medications, as well as individualized nutrition plans. Virta will also place its fees at risk for all customers, regardless of the members’ individual journey, with performance targets connected to deprescription of GLP-1’s, as well as sustained weight loss after deprescription.

Members can achieve clinical weight loss without the use of medications, or with medications in combination with Virta’s personalized nutrition therapy. Members can also decide they don’t want to be on GLP-1s long term and use Virta as a safe and sustainable off-ramp to the drugs while maintaining a healthy weight.