Therapeutic inertia related to the injectable glucagon-like peptide-1 receptor agonists dulaglutide and semaglutide in patients with type 2 diabetes in UK primary care

Aims: To determine the extent of therapeutic inertia related to the weekly injectable glucagon-like peptide-1 receptor agonists dulaglutide and semaglutide in patients with type 2 diabetes (T2D) in the United Kingdom.Materials and methods: Adults with T2D who received their first primary care pre-scription of dulaglutide or semaglutide between January and July 2019 were identi-fied from the UK Clinical Practice Research Datalink GOLD primary care database. Doses prescribed, glycated haemoglobin (HbA1c), body mass index (BMI) and con-comitant T2D medications were assessed at first prescription and at 3, 6 and 9 months. Results: Of the patients prescribed dulaglutide (N = 748; mean [SD] age 59.0 [11.2] years) and semaglutide (N = 437; mean [SD] age 58.4 [10.6] years), 93.0% and 89.0%, respectively, had an HbA1c level >= 7.5% (>= 58.46 mmol/mol), and 56.4% and 54.9%, respectively, had an HbA1c level >= 9.0% (>= 74.86 mmol/mol), at first prescription. At 6 to 9 months, 75.0% of those on dulaglutide 0.75 mg and 57.6% of those on semaglu-tide 0.25 mg or 0.5 mg had an HbA1c level >= 7.5% (>= 58.46 mmol/mol). At 9 months, 21.9% of the dulaglutide cohort were on the suboptimal dose of 0.75 mg, and 46.1% of the semaglutide cohort were on the suboptimal doses of 0.25 mg or 0.5 mg.Conclusions: Multiple examples of therapeutic inertia were identified, including first prescription at HbA1c levels considerably above target and failure to escalate to opti-mal doses even with evidence of suboptimal metabolic control. A substantial propor-tion of patients therefore did not achieve optimal HbA1c targets.