SUN-543 - Changes in BMI, Hga1C and Glycemic Control after GLP-1 Initiation in Veterans using Insulin Pump

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) not only provide glycemic control but also weight loss and cardiometabolic benefits. Data on their use among Veterans receiving insulin pump therapy remain limited.

Objective: To evaluate changes in body mass index (BMI), hemoglobin A1c (HgA1c), and glycemic control following initiation of GLP-1 RAs in veterans using insulin pump therapy.

Methods: Data (2022-2025) from electronic medical records and insulin pump downloads (Medtronic and Tandem) were extracted. Veterans using an insulin pump and continuous glucose monitoring (CGM) were included. Patients who had started GLP-1 RA therapy were assigned as cases, whereas those who had not, were assigned as controls. Cases and controls were matched based on sex, age, and BMI with a +/- 10 % variance. We reviewed the changes in BMI and HgA1c 6-9 months in both groups. CGM data such as mean glucose and glucose management indicator (GMI) were averaged to 14 days and compared before and 3 months after starting GLP-1 RA therapy. A paired T-test was used to analyze data. There were 9 cases (mean age 67.3 ± 12.6, 8 were males, 55% T1D) and 18 controls (mean age 67.8, SD 8.6, 17 males, 61% T1D). The most common indication for GLP-1 RA therapy was diabetes (uncontrolled or with coronary artery disease 6/9) and obstructive sleep apnea (3/9). Nearly all cases and controls had hypertension and obstructive sleep apnea.

Results: The before and after parameters of patients who were treated with GLP-1- RAs averaged as follows: BMI 33.4 kg/m2 (SD 4.36) and 31.8 (SD 6.50), p=0.09, HgA1c 7.4 (SD 0.7) and 7.2 (SD 1.34) p=NS, GMI 7.4% (SD 0.5) and 7.0 (SD 0.5) p< 0.01, CGM mean glucose 168.1 mg/dl (SD 19.8) and 155.7 (SD 17.6) p< 0.01.

Among controls, their parameters during the same period of time remained mostly unchanged without statistical difference: BMI 32.8 kg/m2 (SD 3.3) and 32.7 (SD 3.3), HgA1c 7.1 (SD 0.9) and 7.1 (SD 1.0), GMI 6.8% ± 0.5 and 6.9% (SD 0.4), CGM mean glucose 149.2 mg/dl (SD 20.0) and 150.5 (SD 18.3).

Conclusions: In this case-control study, the use of GLP-1 RAs was associated with improvement in glycemic control among veterans using insulin pump therapy. The significant improvements in GMI and mean glucose, despite a non-significant change in HgA1c, highlight CGM-derived metrics as more sensitive indicators of glycemic improvement, particularly in a short follow-up period.

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