doi:10.1016/j.eclinm.2025.103680 Study period 1/1/2017 to 12/31/2025 Study population: inclusion Adult patients with: T ype 2 diabetes A GLP-1 order lasting at least 90 days in the study period On at least one other non-insulin diabetes medication at the time of their HbA1c measurement after stopping the GLP-1 A reduction in HbA1c while on GLP-1 Study population: exclusion Pregnancy during GLP-1 use or follow-up period Patients on insulin Patients with type 1 diabetes: ICD-10-CM code E10* Censoring Patient begins a GLP-1 medication again Exposures Time since stopping GLP-1: three months, six months, nine months, twelve months Outcomes Change in HbA1c from the closest value to the GLP-1 end date and the nearest value to three, six, nine, or twelve months (within 30 days of time window) of stopping the GLP-1 Type 2 diabetes A diagnosis with ICD-10-CM code E11* GLP-1 Order of a simple generic of dulaglutide, exenatide, exenatide microspheres, liraglutide, semaglutide, or tirzepatide and a pharmaceutical class of ANTIHYPERGLYCEMIC INCRETIN MIMETICS COMBINATION, ANTIHYPERGLY,INSULIN,LONG ACT-GLP-1 RECEPT.AGONIST, ANTI-OBESITY GLUCAGON-LIKE PEPTIDE-1 RECEP AGONIST, ANTIHYPERGLY,INCRETIN MIMETIC(GLP-1 RECEP.AGONIST), or ANTI-OBESITY INCRETIN MIMETICS COMBINATION Pregnancy Pregnancy start date: Between 12 months before the first reading through the follow-up reading Pregnancy end date, delivery, or if its ambiguous what point in the pregnancy the patient would be at (e.g., an encounter or billing diagnosis with ICD-10-CM O*): Between 12 months before the first reading through 9 months after the follow-up reading Non-insulin diabetes medications SGLT2i: ATC code A10BK* Biguanides: ATC code A10BA* Sulfonylureas: ATC code A10BB* DPP-4 inhibitor: ATC code A10BH* Combination HbA1c A lab result with LOINC code 17856-6, 17855-8, 4548-4, or 4549-2 Insulin A medication with ATC code A10A* Race and ethnicity Non-exclusive flags for Black race and Hispanic ethnicity Limitations Medications prescribed outside participating health systems might be missing on patients records
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