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Practical Considerations and Rationale for Glucagon-Like Peptide-1 Receptor Agonist Plus Sodium-Dependent Glucose Cotransporter-2 Inhibitor Combination Therapy in Type 2 Diabetes

Published:September 14, 2020DOI:https://doi.org/10.1016/j.jcjd.2020.09.005

      Abstract

      Glucagon-like peptide-1 receptor agonists and sodium-dependent glucose cotransporter-2 inhibitors have demonstrated clinically significant benefits on glycated hemoglobin, weight, blood pressure and cardiorenal outcomes. The emerging evidence from clinical trials and meta-analyses that assessed the combination of these 2 classes of drugs has been promising. An expert forum that included individuals with expertise in endocrine, cardiology and nephrology issues was held in May 2020 to review the literature on the metabolic and cardiorenal benefits of these 2 classes, independently and in combination, in adults with type 2 diabetes mellitus. Although hard outcome data are not available, the group concluded that the combination of glucagon-like peptide-1 receptor agonists with sodium-dependent glucose cotransporter-2 inhibitors is an emerging option for managing adults with type 2 diabetes as long as cost is not a barrier. Ongoing research may offer further insights on hard cardiorenal outcomes for this therapeutic combination as well as provide direction on the potential of this approach in obesity, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis and populations without diabetes.

      Résumé

      Les agonistes des récepteurs du GLP-1 (glucagon-like peptide-1) et les inhibiteurs du cotransporteur sodium-glucose de type 2 ont démontré des avantages cliniquement significatifs sur l’hémoglobine glyquée, le poids, la pression artérielle et les résultats cardio-rénaux. Les nouvelles données d’essais cliniques et de méta-analyses qui portent sur l’évaluation de la combinaison de ces 2 classes de médicaments s’avèrent prometteuses. Un forum d’experts qui regroupait des spécialistes des questions portant sur l’endocrinologie, la cardiologie et la néphrologie a eu lieu en mai 2020 dans le but de passer en revue la littérature sur les avantages métaboliques et cardio-rénaux de ces 2 classes de médicaments, administrés de façon indépendante ou en combinaison, chez les adultes atteints du diabète sucré de type 2. Bien que les données objectives sur les résultats ne soient pas disponibles, le groupe a conclu que la combinaison des agonistes des récepteurs du GLP-1 et des inhibiteurs du cotransporteur sodium-glucose de type 2 est une option émergente pour la prise en charge des adultes atteints du diabète de type 2, à condition que les coûts ne constituent pas un obstacle. La recherche actuelle peut offrir d’autres perspectives sur les résultats cardio-rénaux tangibles de cette combinaison thérapeutique et donner une orientation sur le potentiel de cette approche chez les personnes obèses, atteintes d’une stéatose hépatique non alcoolique ou d’une stéatohépatite non alcoolique, et chez les personnes non diabétiques.

      Keywords

      Mots clés

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