Improving key metabolic parameters in patients with type 2 diabetes can be challenging in primary care, and integration of diabetes services within the community plays a vital role. GLP-1 receptor agonists and SGLT2 inhibitors are effective at improving glycemic control and weight, and once weekly GLP-1 receptor agonists can improve the adherence to therapy. In this retrospective observational study, we examined the outcomes in primary care practices within the West Berkshire Clinical Commissioning Group.
Methods: We identified 313 patients who had been started on a combination of dulaglutide and empagliflozin (either exclusively or as an add-on). Clinical and metabolic parameters (HbA1c, weight, blood pressure, ALT, cholesterol and eGFR) were measured prior to, and at 3, 6 and 12 months after the start of dual treatment. The study population characteristics were as follows: 57% male, age (mean +/- SD) 57 +/-9 years, HbA1c 9.5 +/- 1.6% (80 +/- 17.5 mmol/mol), weight 106.1 +/- 22 kg. Repeated measures ANOVA was used to compare values to baseline.
Results: HbA1c decreased to 8.3% (67mmol/mol) at 3 months and to 8.1% (65mmol/mol) at 12 months (p<0.001); weight decreased by 2.5kg at 3 months and by 5.7kg at 12 months (p<0.001). Blood pressure decreased from 131 to 128mmHg systolic and from 78 to 77mmHg diastolic (p<0.005) at 3 months. ALT decreased from 36.3 to 31.1mmol/L at 3 months and to 29.9mmol/L at 12 months (p<0.001), cholesterol decreased from 4.4 to 4.2mmol/L at 3 months (p=0.005), while eGFR decreased slightly from 79.9 mean to 78 at 3 months (p<0.001).
Conclusion: In this real-world, primary care study of patients with difficult to manage diabetes and increased weight, the use of empagliflozin plus once weekly dulaglutide therapy led to an improvement in glycemic control and other metabolic parameters, and a reduction in weight. These effects could be observed within 3 months of starting dual therapy, and were either maintained or further improved by 12 months.
I. Spiliotis: None. I.W. Gallen: None.