Endocrine Abstracts

Background: The complex involvement of multiple metabolic defects in the pathogenesis of type 2 diabetes mellitus (T2DM) makes difficult the treatment in monotherapy, therefore, the use of different antidiabetic drugs with different and complementary mechanisms of action could result in better glycemic control with favorable metabolic changes.

Objective: To determine the effectiveness and safety of the addition of a sodium-glucose co-transporter type 2 inhibitor (SGLT2 inhibitors) to patients with T2DM in treatment with a glucagon-like peptide analogue type 1 agonist (GLP1 agonist) and poor metabolic control.

Material and methods: Retrospective observational study. We included all T2DM patients in treatment with a GLP1 agonist who were added a SGLT2 inhibitor due to poor metabolic control. Clinical, biochemical and side effects were analyzed at baseline and after a mean treatment period of 6 months. Statistical analysis (SPSS v. 20.0): Wilcoxon test.

Results: We evaluated 62 patients (31M and 31W) with a mean age (mean±S.D.) of 54.55±9.19 years and an evolution of T2DM of 12.1±6.5 years. 21.5% were on treatment with Dulaglutide+Dapagliflozin, 19.4% Liraglutide+Canagliflozine, 11.3% Liraglutide+Empagliflozine, 16.1% Dulaglutide+Canagliflozine, 8.1% Liraglutide+Dapagliflozin, 6.4% Dulaglutide+Empagliflozine, 6% Exenatide+Dapagliflozin, 4.8% Exenatide+Empagliflozine, 4.8% Exenatide+Canagliflozine and 1.6% Lixisenatide+Dapagliflozin. At baseline, they had a FPG of 188.4±53.6 mg/dl, an HbA1c of 8.85±1.7%, a SBP of 133.7±12.5 mmHg, a DBP of 77.7±7.7 mmHg, a weight of 95.35±24.05 kg, a BMI of 34.47±6.5 kg/m² and a dose of basal insulin (n=12) 35.75±18.82 IU/d (0.38±0.21 IU/kg per day). After a mean treatment period of 6.2±3.2 months, there was a significant reduction in FPG (46.04±61.01 mg/dl less (P=0.003)), HbA1c (1.2±1.7% less (P=0.002)), weight (2.49±5.75 kg less (P=0.019)) and BMI (0.67±1.79 less (P=0.02)). There was no significant reduction in basal insulin requirements (4.16±11.76 IU/d (0.04±0.12 IU/Kg/d) (P=0.49)) and blood pressure (SBP (2.95±14.82 mmHg (P=0.46) and DBP (2.27±10.42 mmHg (P=0.25)). There were no cases of treatment withdrawal due to side effects.

Conclusion: The combination of GLP1 agonists and SGLT2 inhibitors may have an additive or synergistic effect with potential favorable results in terms of improved glycemic control and weight reduction.