Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
Larger waist circumference, higher blood pressure, inflammation, and insulin resistance contribute to cardiometabolic risk. There is great interest in semaglutide/tirzepatide due to effect on weight loss, yet insurance restrictions limit use. The benefit of these agents in patients without overt T2DM is unknown. Compounded product has become available given the national shortage of GLP-1 agents. We present data from a pharmacist-managed cardiometabolic clinic using compounded GLP-1s in patients with cardiometabolic risk whose insurance coverage for commercially available product was denied.
Research Question or Hypothesis:
Do compounded GLP-1 agonists improve cardiometabolic risk in patients without T2DM?
Study Design:
Retrospective review
Methods:
Patients with cardiometabolic risk factors whose insurance denied coverage for commercially available GLP-1 agents met criteria for inclusion. Patients met with pharmacists weekly to discuss diet and exercise, adverse events, and dose titration of compounded GLP-1. Retrospective review was performed for those who completed 12 weeks of the program; outcomes were compared from baseline. Outcomes included change in metabolic risk factors. Paired-student’s t-test and Chi-squared statistics were utilized.
Results:
Change in Cardiometabolic Risk
|
N=50
|
Avg Baseline
|
Avg 12-week
|
P value
|
|
Weight (pounds)
|
226.9+/-38.9
|
210.8+/-36.5
|
P<0.0001
|
|
BMI (kg/m2)
|
34.6+/-4.2
|
32.2+/-3.9
|
P<0.0001
|
|
Waist Circumference (inches)
|
45.8+/-4.9
|
42.9+/-4.1
|
P<0.0001
|
|
Systolic Blood Pressure (mm Hg)
|
140.9+/-17.9
|
127.0+/-15.0
|
P=0.0001
|
|
Diastolic Blood Pressure (mm Hg)
|
83.6+/-13.6
|
78.3+/-10.1
|
P=0.017
|
|
A1C
|
5.5+/-0.3
|
5.3+/-0.3
|
P<0.0001
|
|
hs-CRP
|
4.9+/-3.6
|
3.7+/-3.32
|
P=0.0004
|
|
Vitamin D
|
37.7+/-21.3
|
47.8+/-23.0
|
P<0.0001
|
Fifty patients (18 males; 32 females) completed the 12-week-followup. Average weight loss was 16.06 +/-7.6 pounds (7% from baseline, p=0.001). Diagnostic criteria for hypertension, prediabetes, BMI>30, and metabolic syndrome were reversed in 24, 15, 15, and 18 patients respectively. Average dose of compounded semaglutide and tirzepatide titrated by 12 weeks was 1.02+/-0.4 and 8.125+/-1.25 mg, respectively.
Conclusion:
A 12-week cardiometabolic program implemented by pharmacists with compounded GLP-1s improved all markers of cardiometabolic risk.
Presenting Author
Diego Benavides BSPS, PharmD. CandidateThe University of Tennessee Health Science Center
Authors
Alex Carmon PharmD
Zup Medical Services
Andrea Martin Pharm.D.
Züp Medical Services
Shannon W. Finks Pharm.D.
University of Tennessee College of Pharmacy