Aims: GLP-1 agonist treatment is not universally effective; factors that help predict treatment response are needed. ABCD conducted two nationwide audits on exenatide and liraglutide use in clinical practice.

Methods: Anonymised data on 9020 patients from 126 and 65 centres across UK for both audits were pooled together for analyses. Univariate analyses tested latest HbA1c and weight changes by 6 months as continuous response variables, against other continuous variables of baseline HbA1c, weight, weight or HbA1c change, age, diabetes duration, total insulin dose (logarithm-transformed) and insulin dose reduction. Categorical variables assessed were gender, ethnicity (Caucasian/South Asian/Afro-Caribbean), insulin use and oral hypoglycaemic change (reduced/unchanged/increased). Significant findings were entered into stepwise regression analyses.

Results: 5407 and 5245 HbA1c and weight results were analysed. Univariate analyses showed HbA1c reduction being associated with baseline HbA1c and inversely with baseline weight, weight reduction, diabetes duration, thiazolidinedione (TZD) reduction, insulin use, insulin dose reduction (all p<0.001) and insulin dose (p=0.012). Weight reduction was associated with baseline weight, age, diabetes duration, TZD reduction, insulin use and insulin dose reduction, and inversely with baseline HbA1c, HbA1c reduction and South Asian or Afro-Caribbean ethnicity (all p<0.001). Stepwise regression in 3982 patients showed greater HbA1c reduction being independently associated with higher baseline HbA1c, lower baseline weight, shorter diabetes duration, less TZD reduction and non-insulin use. Stepwise regression in 3089 patients showed greater weight reduction being independently associated with higher baseline weight, lower baseline HbA1c, longer diabetes duration, greater age, more TZD reduction and insulin use. Models on insulin patients showed greater HbA1c reduction being independently and inversely associated with total insulin dose and insulin dose reduction, and greater weight reduction with insulin dose reduction.

Conclusions: Clinically useful findings were that patients who were insulin-treated, had higher insulin dose, and longer diabetes duration, achieved poorer HbA1c reduction with GLP-1 agonist treatment. In contrast, insulin-treated patients achieved greater weight reduction.