Endocrine Abstracts

Background: Dapagliflozin was the first SGLT2 inhibitor licensed in UK to improve glycaemic control in type 2 diabetes. Whilst it has not been studied for use in combination with GLP1 agonists the modes of action of the two therapies suggest they would be a logical therapeutic combination. We aimed to evaluate clinical experience with this regimen.

Methods: Observational retrospective data was collected from electronic patient records (SCI–diabetes) on all patients prescribed dapagliflozin as an addition to GLP1 agonist across two Scottish health board areas. HbA1c, weight, BP, cholesterol, HDL, ALT, AST:ALT ratio, and eGFR change at 6–18 months were compared to baseline. Discontinuation of therapy and adverse events were recorded.

Results: Eighty-five patients were included (47 males, mean age mean diabetes duration 13 years). All eGFRs were >60 on initiation. 74 patients were on liraglutide at initiation and 11 on exanitide preparations. Five patients (8.5%) stopped dapagliflozin during study period. Duration of therapy studied was between 3 and 18 months. Median HbA1c (mmol/mol) at initiation was 76 (IQR 67.5–88) and at 12 months was 64 (56–71.5) (P≤0.001). Baseline Systolic BP was 132 mmHg (IQR 120–143) and at 12 months was 128 mmHg (120–135). Baseline diastolic BP was 79 mmHg (73–83) and at 12 months was 77 mmHg (72–86) (P=NS). Weight was 107.8 kg (IQR 90.4–121.4) at baseline reducing to 102.7 kg (IQR 86.4–120) at 12 months (P=NS). No significant change in cholesterol, HDL, ALT, AST:ALT ratio, and eGFR were found post treatment. Adverse events documented included genital mycosis in 9/85 (9.4%) and volume depletion 4/85 (4.7%).

Conclusions: The addition of dapagliflozin to GLP1 therapy appears to effectively reduce HbA1c in type 2 diabetes patients. A non-significant reduction in weight and BP was found. The addition of dapagliflozin to GLP1 therapy offers promise for treatment of type 2 diabetes.