Weight loss differences seen between glucagon-like peptide–1 receptor agonists and sodium–glucose cotransporter–2 inhibitors for treatment of type 2 diabetes

Abstract

BackgroundWeight loss is an advantageous quality for diabetic medications because it can improve insulin sensitivity and glucose control and reduce cardiovascular risk factors and comorbidities. Glucagon-like peptide–1 (GLP-1) receptor agonists and sodium–glucose cotransporter–2 (SGLT-2) inhibitors are both preferred agents for use after metformin therapy, and both cause modest weight loss. ObjectiveThe aim of this study was to evaluate the difference in weight loss between GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes (T2D). MethodsThis was a retrospective study that was conducted at a level 3 patient-centered medical home in Buffalo, NY. The participants were adults with T2D treated with either a GLP-1 receptor agonist or an SGLT-2 inhibitor, in addition to background diabetes medications, between January 1, 2012, and September 20, 2017. The outcome measures included the median weight loss after 6 months of consecutive therapy compared between the 2 antidiabetic classes and the median differences in blood pressure, glycosylated hemoglobin (A1C) levels, and renal function markers compared between the 2 classes. ResultsA total of 73 patients were included in the final analysis, with 31 receiving SGLT-2 inhibitors and 42 receiving therapy with GLP-1 receptor agonists. The SGLT-2 inhibitor cohort presented a median weight loss of –2.80 kg (interquartile range [IQR] –5.40 to –1.50), and the GLP-1 receptor agonist cohort presented a median weight loss of –1.15 kg (IQR –3.38 to 0.975) (P = 0.014). There were no statistically significant differences in A1C levels, blood pressure, or renal function markers. ConclusionSGLT-2 inhibitors, when used in combination with background diabetes regimens, can lead to more statistically significant weight loss than GLP-1 receptor agonists without compromising renal function.