Juana Carretero Gómez1, José Carlos Arévalo Lorido2, Ricardo Gómez Huelgas3, Dolores García de Lucas4, Lourdes Mateos Polo5, José Manuel Varela Aguilar6, Jose Miguel Seguí Ripoll7, Javier Ena8. 1. Internal Medicine Department, Zafra Hospital, Ctra Badajoz-Granada, s/n, 06300 Zafra, Badajoz, Spain. Electronic address: juanicarretero@gmail.com. 2. Internal Medicine Department, Zafra Hospital, Ctra Badajoz-Granada, s/n, 06300 Zafra, Badajoz, Spain. 3. Internal Medicine Department, Regional University Hospital of Málaga, Avda de Carlos Haya, s/n, Málaga, Spain; Institute of Biomedical Research in Malaga, CIBER Physiopathology of Obesity and Nutrition, Malaga, Spain. 4. Internal Medicine Department, Costa del Sol Hospital, Autovía A7, Km 187, Marbella, Málaga, Spain. 5. Internal Medicine Department, University Hospital of Salamanca, Paseo de San Vicente 182, Salamanca, Spain. 6. Internal Medicine Department, Biomedical Research Centre Network for Epidemiology and Public Health, Virgen del Rocío University Hospital, Av. Manuel Siurot, s/n, Sevilla, Spain. 7. Internal Medicine Department, San Juan de Alicante University Hospital, Ctra Alicante-Valencia, s/n, San Juan, Alicante, Spain. 8. Internal Medicine Department, Marina Baixa Hospital, Avda. Alcalde En Jaume Botella Mayor, s/n, La Vila Joiosa. Alicante, Spain.
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.
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.
Keywords:
agonistes des récepteurs du GLP-1; body weight; du poids corporel; glucagon-like peptide-1 receptor agonists (GLP-1ra); glycemic control; inhibiteurs du cotransporteur sodium-glucose de type 2; older patient; patients âgés; régulation de la glycémie; sodium-glucose cotransporter 2 inhibitors (SGLT2i)