Combination therapy with GLP-1 analogues and SGLT-2 inhibitors in the management of diabesity: the real world experience
- 941 Downloads
Diabesity—obesity resulting in diabetes—is a major health problem globally because of the obesity epidemic. Several anti-diabetic medications cause weight gain and may worsen obesity, and possibly diabeisty. Two recent small retrospective cohort studies showed weight loss and diabetes improvement with combination of glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose co-transporter type-2 (SGLT-2) inhibitors in obese subjects. We assessed the effect of combination therapy with GLP-1 agonists and SGLT-2 inhibitors in the management of diabesity in a retrospective study at the Wolverhampton Diabetes Centre. Out of 79 patients on this combination regimen with other anti-diabetic medications, 37 cases who had follow up at 3–6 months were studied. Mean age and duration of follow up were 57.4 (+/−7.8) and 139 (+/−32.6) days, respectively. Twenty-two patients (59.5 %) were Asians. Statistically significant improvements in clinical parameters such as body weight reduction (3.07 kg), glycated haemoglobin (HbA1c) reduction (1.05 %), lower BMI (−1.13 kg/M2) and insulin dose reduction (6.8 units) were observed (p < 0.05 for all) in patients on combination regimen. Linear regression analysis showed that baseline HbA1c and baseline insulin dose were independent predictors of HbA1c reduction and insulin dose reduction, respectively. Our results suggest that combination therapy with GLP-1 agonists and SGLT-2 inhibitors is a promising option for patients with diabesity.
KeywordsDiabesity Glucagon-like peptide-1 (GLP-1) agonist Sodium-glucose co-transporter type-2 (SGLT-2) inhibitors Management of diabesity Anti-diabetic combination regimen
No funding was received for this work
Compliance with ethical standards
Conflict of interest
Ananth K Viswanath received lecture fees from MSD, Novo Nordisk, Takeda, Eilly Lilly, Jansen and sponsorship from Novo Nordisk, Takeda, Novartis and Jansen to attend international conferences. The remaining authors have no conflicts of interest to declare.
Both the first and second authors contributed equally to the research and preparation of the manuscript.
- 1.World Health Organization. Obesity and overweight. Geneva, Switzerland: World Health Organization, 2015. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 30 March 2016
- 3.P.R. Schauer, D.L. Bhatt, J.P. Kirwan, K. Wolski, S.A. Brethauer, S.D. Navaneethan, A. Aminian, C.E. Pothier, E.S. Kim, S.E. Nissen, S.R. Kashyap, STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N. Engl. J. Med. 370, 2002–2013 (2014)CrossRefPubMedGoogle Scholar
- 4.G. Mingrone, S. Panunzi, A. De Gaetano, C. Guidone, A. Iaconelli, G. Nanni et al., Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386(9997), 964–973 (2015)CrossRefPubMedGoogle Scholar
- 9.K. Esposito, P. Chiodini, A. Capuano, M.I. Maiorino, G. Bellastella, D. Giugliano, Baseline glycemic parameters predict the hemoglobin A1c response to DPP-4 inhibitors : meta-regression analysis of 78 randomized controlled trials with 20,053 patients. Endocrine 46, 43–51 (2014)CrossRefPubMedGoogle Scholar
- 11.J. Rosenstock, L. Hansen, P. Zee, Y. Li, W. Cook, B. Hirshberg, N. Iqbal, Dual add-on therapy in type 2 diabetes poorly controlled with metformin monotherapy: a randomized double-blind trial of saxagliptin plus dapagliflozin addition versus single addition of saxagliptin or dapagliflozin to metformin. Diabetes Care 38, 376–383 (2015)CrossRefPubMedGoogle Scholar
- 12.R. Huxley, W.P. James, F. Barzi, J.V. Patel, S.A. Lear, P. Suriyawongpaisal, E. Janus, I. Caterson, P. Zimmet, D. Prabhakaran, S. Reddy, M. Woodward, Obesity in Asia Collaboration. Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension. Obes. Rev. 9(Suppl 1), 53–61 (2008)CrossRefPubMedGoogle Scholar
- 15.N.M. Maruthur, E. Tseng, S. Hutfless, L.M. Wilson, C. Suarez-Cuervo, Z. Berger, Y. Chu, E. Iyoha, J.B. Segal, S. Bolen, Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann. Intern. Med. 164, 740–751 (2016)CrossRefPubMedGoogle Scholar
- 25.S.E. Inzucchi, R.M. Bergenstal, J.B. Buse, M. Diamant, E. Ferrannini, M. Nauck et al., Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 38, 140–149 (2015)CrossRefPubMedGoogle Scholar