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Combination Therapy With Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors in Older Patients With Type 2 Diabetes: A Real-World Evidence Study

Published:September 08, 2018DOI:https://doi.org/10.1016/j.jcjd.2018.09.001

      Abstract

      Objectives

      Scientific literature about the combination of glucagon-like peptide-1 receptor agonists (GLP-1ra) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients is scarce. We sought to assess the real-world efficacy and safety of SGLT2 inhibitors and GLP-1ra combination therapy in older patients (>65 years of age).

      Methods

      This was an observational, prospective, multicenter study based on clinical practice. Patients were stratified according to tertiles of baseline glycated hemoglobin (A1C) levels and to treatment schedule.

      Results

      We included 113 patients (65.5% men, mean age 70.4±8.8 years). The body mass index was 36.5 (±6.6) kg/m2. The baseline A1C level was 8.0% (±1.2%). At the 6-month follow up, we found a significant reduction in A1C levels (–1.1%; p<0.0001), body mass index (–2.1 kg/m2; p<0.00003) and systolic blood pressure (–13 mmHg; p<0.000005). Patients who had the highest baseline A1C levels (≥8.4%) showed greater improvement in A1C levels (p<0.0001), weight (p<0.0001) and quality-of-life scores (p<0.0001). The greatest reduction in A1C levels and weight was seen in patients who started both drugs simultaneously (p<0.0001). The second greatest reduction was seen when GLP-1ra was added to previous treatment with an SGLT2i (p<0.0001). Also of note was a decrease in systolic blood pressure in patients for whom an SGLT2i was added to previous GLP-1ra treatment (p<0.0001). Of the patients, 34.3% achieved the combined endpoint of A1C levels <7% and weight loss ≥5% without hypoglycemia.

      Conclusions

      This study's findings provide evidence of clinically meaningful reductions in A1C level, body weight and systolic blood pressure in older patients with type 2 diabetes who are taking combined regimens. The dropout and hypoglycemia rates were minimal, and treatment was tolerated well.

      Résumé

      Objectifs

      La littérature scientifique sur la combinaison des agonistes des récepteurs du GLP-1 et des inhibiteurs du SGLT2 chez les patients âgés est peu abondante. Nous avons cherché à évaluer l'efficacité et l'innocuité en contexte réel de la combinaison des inhibiteurs du SGLT2 et des agonistes des récepteurs GLP-1 chez les patients âgés (>65 ans).

      Méthodes

      Il s'agissait d'une étude observationnelle, prospective et multicentrique fondée sur la pratique clinique. Nous avons réparti les patients en fonction des tertiles des concentrations initiales de l'hémoglobine glyquée (A1c) et du schéma thérapeutique.

      Résultats

      Nous avons sélectionné 113 patients (65,5 % d'hommes, âge moyen de 70,4±8,8 ans). L'indice de masse corporelle était de 36,5 (±6,6) kg/m2. La concentration initiale de l'A1C était de 8,0 % (±1,2 %). Au suivi après 6 mois, nous avons observé une réduction significative des concentrations de l'A1C (–1,1 %; p<0,0001), de l'indice de masse corporelle (–2,1 kg/m2; p<0,00003) et de la pression artérielle systolique (–13 mmHg; p<0,000005). Les patients qui avaient les concentrations initiales les plus élevées de l'A1C (≥8,4 %) montraient une plus grande amélioration des concentrations de l'A1c (p<0,0001), du poids (p<0,0001) et des scores de qualité de vie (p<0,0001). Une plus grande réduction des concentrations de l'A1C et du poids était observée chez les patients qui commençaient simultanément les deux médicaments (p<0,0001).
      La deuxième plus grande réduction était observée lors de l'ajout des agonistes des récepteurs du GLP-1 au traitement par inhibiteur du SGLT2 (p<0,0001). On notait aussi une diminution de la pression artérielle systolique chez les patients auxquels on avait ajouté un inhibiteur du SGLT2 au traitement par agoniste des récepteurs du GLP-1 (p<0,0001). Parmi les patients, 34,3 % atteignaient le critère d'évaluation combiné (concentrations de l'A1c<7 % et perte de poids≥5 % sans hypoglycémie.

      Conclusions

      Les résultats de la présente étude montrent des preuves de réductions significatives des concentrations de l'A1c, du poids corporel et de la pression artérielle systolique chez les patients âgés atteints du diabète de type 2 qui suivent un schéma posologique combiné. Les taux d'abandon et d'hypoglycémie étaient minimes, et le traitement était bien toléré.

      Keywords

      Mots clés

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