Addition of SGLT2 inhibitor to GLP-1 agonist therapy in people with type 2 diabetes and suboptimal glycaemic control

Abstract

This study aimed to observe the effect of the novel combination of dual add-on therapy of a sodium-glucose co-transporter-2 (SGLT2) inhibitor to a glucagon-like peptide-1 receptor agonist (GLP-1 RA) on glycaemic control and weight in patients with suboptimal diabetes control who are already on antidiabetic treatment after failure of a GLP-1 RA therapy alone. We conducted a retrospective observational case note review of patients who had a minimum of 12 weeks’ treatment with a GLP-1 RA added onto their previous regimen followed by the addition of an SGLT2 inhibitor. HbA1c and weight were measured routinely. Dual therapy with a GLP-1 RA and an SGLT2 inhibitor was associated with a significantly larger reduction in HbA1c than therapy with a GLP-1 RA (25.5mmol/mol vs 8mmol/mol; p < 0.05) on the background of the usual diabetic regimen at week 20; this effect was sustained at week 48. There was an additional benefit of further weight loss in 58% of the patients on dual add-on therapy compared to single GLP-1 therapy at 48 weeks. In conclusion, patients with type 2 diabetes who require further improvement in glycaemic control despite the addition of a GLP-1 RA to their regimen can be considered for an SGLT2 inhibitor. The mechanism of action may be synergistic and has the advantage of promoting further weight loss. Copyright © 2016 John Wiley & Sons.