Abstract
Objective: We investigated the relationship between enhanced efficacy of incretin-related drugs with add-on SGLT2 inhibitor therapy in type 2 diabetic patients and their background characteristics. Patients and Methods: 1) Add-on SGLT2i therapy was given to a total of 15 type 2 diabetic patients with insufficient glycemic control despite conventional therapy including DPP-4i for 2 months in an outpatient setting. 2) Likewise, add-on SGLT2i therapy was given to a total of 17 type 2 diabetic patients with insufficient glycemic control despite conventional therapy including GLP-1RA for 3 months in an outpatient setting. In both groups, the glycemic variability (GV) was compared before and after add-on SGLT2i therapy by using CGM. GV indices evaluated included the difference before and after SGLT2i therapy in SD of 24-hour glucose values (ΔSD), the 24-hour total GV area (ΔSQ), and MAGE (ΔMAGE). Both groups were further divided according to the GV results by over 50th %tile and under 50th %tile into high-responders (n = 8 and 9) and low-responders (n = 7 and 8). Results: 1) Effect of add-on SGLT2i therapy on reductions in GV in those receiving DPP-4i: High-responders were shown to be associated with significantly higher mean glucose values, SD, SQ and MAGE than low-responders at baseline (P < 0.05). 2) Effect of add-on SGLT2i therapy on reductions in GV in those receiving GLP-1RA: high-responders were shown to be associated with significantly lower BMI, as well as significantly higher SD and SQ than low-responders at baseline (P < 0.05). Conclusions: With 2-month SGLT2i therapy as add-on to DPP-4i, reductions were seen in GV among patients with higher mean glucose and greater GV at baseline, suggesting a role for add-on SGLT2i therapy particularly in those with poor glycemic control. In contrast, with 3-month SGLT2i therapy as add-on to GLP-1RA, reductions were seen in GV among those with less severe obesity and greater GV at baseline. Disclosure T. Onishi: None. Y. Shioda: None. Y. Mori: None.
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