Objective: To assess the effects of addition of a combination of GLP-1 receptor agonist (GLP-1RA), injection DU 1.5 mg weekly and SGLT2 inhibitor (SGLT2i), CAN 100mg/day in T2 D obese Asian Indian patients sub-optimally controlled on metformin and other agents [sulfonylurea (SU) 71%, insulin 29%].
Methods: Impact of DU and CAN on HbA1c (A1c), weight (wt.), systolic blood pressure (SBP), lipids and dose of previous antidiabetic agents at week 16, 32 and 52 was analyzed retrospectively.
Results: Fifty-five patients (31M/24F, age 51±5.8 y, wt. 92.6±3.4 kg, BMI 31.1±2.1kg/m2, SBP 142.4±3.9mmHg, eGFR 62± 5mL/minutes/1.73m2, with 8.4±3.3 years duration of diabetes) met the inclusion criteria. In 71% subjects, A1c decreased by 1.6% [8.5±0.4 to 7.1±0.2, P<0.0001] at week 16 and dropped to 6.8±0.3 (P=0.0002) in 18% (week 32) but rose by 0.26% (P=0.0056) in 11% (week 40-52). At week 16, wt. was - 4.1 kg (92.6±3.4 to 88.5±3.6, P<0.0001). By week 32, 68% lost another 3.3±0.7 kg (P<0.0001) while 10% regained 1.1±0.6 kg (P=0.077). A drop in SBP of 4.1±0.8 mmHg (P<0.0001) was seen in 74.5% patients and 53% of these needed reduction in doses. A decrease in triglyceride (189.6±8.1 to 168.4±6.9 mg/dL, P<0.0001) and LDL-cholesterol (107.5±4.7 to 104.2±4.9 mg/dl, P=0.0004) occurred. At week 16, 50% required reduction in insulin dose and 15% stoppage. Increase in basal insulin dose/addition of prandial insulin was needed in 5% (week 39-52). By week 16, SU dose had to be halved in 56% and discontinued in others because of minor episodes of hypoglycemia. With CAN, genital and urinary tract infections were seen in 5.9% (2 F/1M) and 3.6% respectively. None had to stop therapy. With DU, nausea (18.1%), vomiting (14.5%) and diarrhea (7.2%) occurred but none had to stop therapy.
Conclusion: Combination Therapy of GLP-1 RA and SGLT2i in obese T2D patients provides statistically significant and durable glycemic control, with favorable effects on weight, BP and lipids and is also well tolerated.
A. Nigam: None.
