Evaluation of Glycemic Control and Cost Savings Associated With Liraglutide Dose Reduction at a Veterans Affairs Hospital.

PURPOSE: As a result of a cost savings initiative, the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, selected liraglutide as its preferred glucagon-like peptide 1 receptor agonist for the treatment of patients with type 2 diabetes mellitus with a preferred maximum daily dose of 1.2 mg. With this change, several veterans were converted from liraglutide 1.8 mg daily to 1.2 mg daily; however, the benefit of this change remains unknown. The objective of this study was to assess sustained glycemic control and cost savings that resulted from the liraglutide dose reduction. METHODS: A retrospective chart review was conducted to include veterans on liraglutide 1.8 mg daily and insulin and/or other antihyperglycemic agents who were converted to liraglutide 1.2 mg daily between May 2018 and August 2018. Demographic data, hemoglobin A (HbA), serum glucose levels, body weight, prescriber type, and medication history were obtained using the Computerized Patient Record System. Veterans' charts were evaluated over a 6-month evaluation period, and descriptive statistics and paired tests were used to analyze results as appropriate. RESULTS: A total of 97 veterans were included. At the time of conversion, the average (SD) HbA was 8.2% (1.4), and body average (SD) weight was 116.2 kg (23.2). Six months after the dose conversion, average (SD) HbA increased to 8.7% (1.8) (95% CI, -0.76 to -0.22; = .0005), and average (SD) body weight increased to 116.5 kg (24.6) (95% CI, -2.11 to 1.64; = .8). To account for the HbA increase, 41.2% of veterans underwent an insulin dose increase, whereas 40.2% of veterans had no medication dose changes. An estimated annual cost savings of $230,922.72 resulted from the liraglutide dose reduction. CONCLUSIONS: Dose reduction of daily liraglutide treatment from 1.8 mg to 1.2 mg was associated with HbA increase, increased insulin requirements, and cost savings. A cost effectiveness analysis is needed to assess overall benefit of the liraglutide dose reduction initiative.