Glucagon-Like Peptide-1 Receptor Agonists Added to Sodium-Glucose Cotransporter 2 Inhibitors in Type 2 Diabetes: A Historical Cohort Study Using the Diabetes Study From the Center of Tokyo Women's Medical University (DIACET)

Abstract

Background: This study clarifies the effects of adding a glucagon-like peptide-1 receptor agonist (GLP-1RA) to sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy on glycated hemoglobin (HbA1c) and body weight in Japanese patients with type 2 diabetes (T2D). Methods: This historical cohort study, part of the Diabetes Study from the Center of Tokyo Women's Medical University, included 80 adults with T2D (registered April 2014-July 2020) prescribed SGLT2i for ≥3 months before adding GLP-1RA. HbA1c and weight changes to 12 months after GLP-1RA prescription were assessed, overall and in subgroups based on previous dipeptidyl peptidase-4 inhibitor use, body mass index (BMI), baseline HbA1c levels, and insulin use. Results: HbA1c was significantly reduced from baseline (mean ± SD: 8.9 ± 1.6%) at all times, including 6 months (primary endpoint: 8.2 ± 1.3%; change: −0.76%, P = 0.002). At 12 months, 21.4% of individuals achieved HbA1c levels <7%. Results were similar in most subgroups. In the BMI ≥30 kg/m2 subgroup, HbA1c was significantly reduced only at 3 months; 15.2% of individuals achieved HbA1c <7% at 12 months. Significant weight changes were observed only in insulin non-users. Conclusions: Adding GLP-1RA to SGLT2i therapy reduced HbA1c levels in Japanese people with T2D; obese individuals may require more intensive treatment.

Keywords

• combination therapy
• glucagon-like peptide-1 receptor agonist
• sodium-glucose transporter 2 inhibitor
• type 2 diabetes