Endocrine Abstracts

Effective management of obesity is increasingly challenging with the continued growth of the nation’s waistlines and bariatric surgery is not the always the answer to this problem. The synergistic action of GLP-1 agonists (GLP1A) and SGLT2 inhibitors (SGLT2I) represents a possible therapeutic approach for patients with Type 2 diabetes (T2DM) and obesity in whom bariatric surgery has been ineffective or is not possible. A single centre retrospective study was performed to assess weight and metabolic response to the combination of GLP1 and SGLT2 inhibitors in patients with T2DM. The cohort consisted of 25 patients with T2DM and BMI>35 kg/m², aged 35–76, 12 male and 13 female, and duration of treatment was 3–29 months (median 10 months). Eight had unsuccessful bariatric surgery 2–12 years previously and none had achieved remission from T2DM. 17 patients were not able to have or did mot want surgery.

Results: In total seven out of 25 patients (28%) achieved an HbA1C of < 48 mmol/mol and weight reduced by a median 7% (4–28%). BMI reduced by median 9% (−2 to 26%) and HbA1C reduced by 20 mmol/mol (6–105). Due to the small sample size, non-parametric testing was used to compare weight, BMI and HbA1C before and after combination treatment. Statistically significant differences were detected in BMI (P=0.00001) and HbA1C (P=0.00001) but not weight (P=0.158). Augmented individual responses were seen; one lost 31 kg with 105 mmol/mol reduction in Hba1C having lost <5%EBW with gastric band. All patients tolerated the combination without significant side effects.

Discussion: Non-surgical weight loss approaches are limited and of the possible pharmacological treatments, only orlistat is freely available on the NHS. Particularly in T2DM, weight loss is often difficult to achieve and maintain but can have significant effects on individuals’ health. This study has shown that in this cohort, GLP1A and SGLT2I provide an effective and well tolerated combination to encourage weight loss and improve glycaemic control in individuals in whom previous bariatric surgery had been unsuccessful or was not possible.