Endocrine Abstracts

Objectives: SGLT2 inhibitors and GLP1 analogs are the treatment of choice after metformin in patients with type 2 diabetes (DM2) and overweight-obesity (OB). The aim of this study is to analyze the effectiveness and safety of these treatments alone or in combination.

Methodology: This is a retrospective observational study in the usual clinical practice. We analyzed the effects of SGLT2 inhibitors and GLP1 analogs treatments in patients with DM2 and OB who have poor metabolic control after metformin. We measured: HbA1c, weight, insulin dose, systolic blood pressure and LDL cholesterol levels at 0, 3, 9 and 15 months. Likewise the proportion of adverse effects were registered.

Results: A total of 90 patients, 48 ​​men and 42 women, with a average age of 62.7 ± 9.7 years were analyzed. At the beginning they had an average BMI of 35.6 ± 7.0 kg/m² andHbA1c of 7.9 ± 1.1%. The average evolution time of DM2 was 12.2 ± 9.4 years and 68.9% patients were insulin dependent with an average initial insulin dose of 37.3 ± 2.6 IU. 23.3% of patients were treated with GLP1 analogs (liraglutide, lisixenatide, weekly exenatide, or dulaglutide), 55.6% were treated with SGLT2 inhibitors (dapaglifozin, canaglifozine, or empaglifozine) and 21.1% with a sequential combination of both. Regarding metabolic control, we observed a significant reduction in HbA1c at 3 months: –0.61 ± 1.20% (P < 0.001), at 9 months: –0.70 ± 1.12% (P < 0.001) and at 15 months: –0.73 ± 1.31% (P = 0.004). Regarding weight, we also found a significant improvement at 3 months: –2.13 ± 2.63 kg (P < 0.001), at 9 months: –3.63 ± 3, 07 kg (P < 0.001) and at 15 months: –3.83 ± 4.14 kg (P < 0.001). Insulinized patients required significantly lower doses of insulin at 3 months: –3.62 ± 7.95 IU (P = 0.001) and at 9 months: –6.45 ± 12.16 UI (P = 0.002), without reaching statistical significance at 15 months: –6.50 ± 17.81 UI (P = 0.12). We didn´t observe significant changes in systolic blood pressure and LDL levels. Finally, we registered adverse effects in iSGLT-2 patients: genital mycosis in 7.8% and urinary tract infections in 4.4%; andina GLP-1 patients: vomiting in 1.1%.

Conclusions: The results of this study corroborate the benefits obtainedin clinical trials with the GLP1 analogs and SGLT2 inhibitors in metabolic and weight control, with a low rate of adverse effects.