Durability of Glycemic Improvement With and After GLP-1 Therapy in a Real-World Remote Monitoring Diabetes Program (RMDP)

Introduction and Objective: A recent systematic review of randomized trials reported clinically meaningful metabolic rebound following GLP-1 RA discontinuation, 0.58% TD1 and 0.65% TD2, with greater worsening over longer follow-up. However, the durability of glycemic improvement after discontinuation in real-world settings is not well understood. This study examined the impact of GLP-1 use on glycemic improvement and sustainability after discontinuation within an RMDP. Methods: We conducted a retrospective cohort analysis of adults (≥18 years) enrolled in Teladoc Health's RMDP on or after January 1, 2022, with up to 24 months of follow-up and started the program uncontrolled (A1c>= 7%). Outcomes were stratified by 12-month GLP-1 adherence using proportion of days covered (adherent: PDC ≥0.8 vs nonadherent: <0.8) and compared with members without observed GLP-1 use. Estimated A1c (eA1c) reduction calculated via Nathan’s method were age adjusted. A one-sample t-test evaluated eA1c change among members adherent to GLP-1s for 12 months who discontinued therapy for the next 12 months. Results: The cohort included 10,654 members (45.4% female; mean age 60.9±10.5 years); 47.8% used GLP-1s during the first year, of whom 76.3% were adherent. Baseline A1cs were 8.9%, 9.0%, and 8.6% for the groups, respectively. Adjusted mean eA1c reduction at 24 months was greatest in the GLP-1 adherent group (−2.6%; SD 2.4%), compared with nonadherent GLP-1 users (−1.8%; 2.6%) and non-GLP-1 users (−1.1%; 2.3%). Among adherent members, 2.5% discontinued GLP-1 therapy after 12 months with a mean difference in A1c reduction at 24 months from 12 months of 0.10%, p-value = 0.43. Conclusion: GLP-1 adherence had greater long-term eA1c reduction than nonadherent and non-GLP-1 users. Members who discontinued GLP-1 therapy after sustained adherence did not experience significant glycemic rebound over 12 months. These findings suggest that RMDPs may support durable glycemic improvement though more study is required. Disclosure: R.A. James: Employee; Current; Teladoc Health. Stock/Shareholder; Current; Teladoc Health. W. Lu: Employee; Current; Teladoc Health. C. Singleton: Employee; Current; Teladoc Health.