Efecto en la vida real sobre el peso y factores de riesgo cardiovascular del tratamiento con agonistas GLP1 en el Área I de Salud de la Región de Murcia

Resum

Obesity is a chronic disease that is increasing worldwide and is associated with high comorbidity and increased mortality. Likewise, its relationship with type 2 diabetes (DM2) and the current trend of the adipocentric approach to its treatment give priority to drugs that have a neutral weight effect or that favor weight loss. Agonists of the glucagon-like type 1 peptide receptor (ar-GLP1) have shown positive effects on body weight and different cardiovascular risk factors, such as blood pressure and lipid parameters, and only cost slightly higher than that of Other therapeutic possibilities would be a factor for greater use in both DM2 and obesity. A correct evaluation of the use of these drugs in the Region of Murcia, analyzing population characteristics and results obtained, can improve the design of cost-effective strategies, which, ultimately, reduce the risk of cardiovascular disease. Objective: To assess in real life the differences in body weight changes and the effect on glycemic control and other CVRF in DM2 patients treated in Health Area I "Murcia Oeste" of the Region of Murcia (AI) Study: Retrospective populational observational with drugs. Materials and methods: Data were collected by reviewing computerized medical records, collected through the Ágora plus regional repository, of 1,820 patients receiving ar-GLP1 treatment, from 2011 to March 2020 to avoid COVID-19 pandemic bias, identified by the data provided by the General Directorate of Pharmacy of the Murcia Health Service (SMS). The variables were evaluated in a first initial visit and a second final visit in all patients from Health Area I Murcia West of the Region of Murcia. Analysis performed with R, a free software environment for graphics and statistical computing that runs on a wide variety of UNIX, Windows and MacOS platforms, version 4.0.3 (R Core Team 2020). Descriptive study of Boxplot type. Inference through ANOVA, correlation of variables according to Pearson's coefficient. Statistical significance was considered if p <0.05 with analysis of the effect size η2, eta squared. Results: The mean duration of treatment with ar-GLP1 was 35 months and the evolution time of DM2 was 9.8 years. 50.9% were men. The mean baseline characteristics of the 1,566 patients were 100 kg, BMI 36.99 kg / m2, and HbA1c 7.73%. With all drugs, a weight loss was evidenced with differences between drugs (η2 = 0.001), with the semaglutide drug being the highest decrease with –4.17 kg. The mean weight at the beginning of treatment in men was higher than that of women with a large effect (η2 = 0.131) and a higher mean decrease in men with a small effect (η2 = 0.003). It was observed that in patients <40 years old, the mean weight at the beginning of treatment was 111.83 kg. In all age groups, a decrease in mean weight was evidenced, with a small effect (η2 = 0.002) being the group <40 years those who had a greater weight loss, with a decrease of –2.45 kg. Patients who achieved a decrease of at least 5% in body weight correspond to 25.5% of the total and 59.3% of patients achieved HbA1c figures <7%. The CVRF and liver profile showed improvements except for systolic blood pressure, which did not show a significant decrease. Conclusions: The therapy with ar-GLP1, in the Murcia West Health Area I of the Murcia Region, had a moderate effect of reducing body weight, although with a notable variability according to sex, age or drug used.