Endocrine Abstracts

Introduction: Multiple studies have evaluated the efficacy of SGLT-2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1ra) in patients with type 2 diabetes mellitus (T2DM). However, their efficacy in clinical practice is less known in patients receiving insulin and few are the studies that compare use of SGLT2i vs GLP1ra as add-on therapy to insulin. This study aims to assess clinical efficacy of both treatments in a cohort of patients with T2DM on insulin and poor glycemic control under routine clinical practice conditions.

Methods/desing: An observational and retrospective study was carried out including 77 T2DM patients on insulin who were added either SGLT2i or GLP1ra to their treatment because of poor glycemic control. Demographic, anthropometric, clinical and therapeutical variables were recorded and compared between groups at baseline and at 24 weeks after add-on. Continuous variables are presented as mean and standard deviation or as median and interquartile range [Q1-Q3] based on data distribution. Categorical variables are presented as frequencies.

Results: SGLT2i was prescribed in 46 patients and 31 patients received GLP1ra. At baseline, both groups were equivalent respect to age, body mass index, weight, time of T2DM duration, dose and regimen of insulin treatment. Female gender rate was higher in GLP1ra group (74.2% vs 30.4%; P<0.001). Differences related to HbA1c-lowering effects and weight loss weren’t observed between groups at 24 weeks after add-on: HbA1c (SGLT2i vs GLP1ra): −1.8±0.3% vs −1.7±0.3%; P=0.73; weight loss (SGLT2i vs GLP1ra): −3±0.7 vs -2.6±0.6 kg; P=0.67. Moreover, no differences were observed neither in rate of patients who lowered insulin dose nor insulin units according to insulin regimen (basal or basal-bolus): Basal régimen (SGLT2i vs GLP1ra): rate of patients who required any decrease in insulin dose (54.5% vs 43.7%; P=0.51), median dose decrease (7 [4–12.5] vs 20 [8–28] IU; P=0.22); basal-bolus or basal-plus (SGLT2i vs GLP1ra): rate of patients who required any decrease in insulin dose (33.3% vs 53.8%; P=0.51), dose decrease (15.5 [7.5–29.5] vs 14 [8–24] IU; P=0.96).

Conclusions: Both SGLT2i and GLP1ra as add-on therapy to insulin result in equivalent HbA1c-lowering effects, weight loss and insulin dose reductions. We didn’t find solid arguments focusing on metabolic control, weight-lowering effects or insuline dose reductions to recommend one or another treatment to optimize outcomes in these patients. Further studies exploring patients preferences and adverse events are needed.