Original ArticlesSGLT-2 Inhibitor Therapy Added to GLP-1 Agonist Therapy in the Management of T2DM
Section snippets
INTRODUCTION
It is estimated that nearly 30 million people in the Unites States, or about 10% of the population, have diabetes (1). Type 2 diabetes mellitus (T2DM) is a heterogeneous and progressive disease that accounts for more than 90% of all diabetes cases. Good glycemic control is associated with a decreased incidence of diabetes-related microvascular and potentially macrovascular complications (2). However, just over half (52.5%) of people with diabetes achieve the American Diabetes
METHODS
This pre-post observational study assessed the efficacy and safety of canagliflozin in a group of T2DM patients from a community endocrinology practice who had received GLP-1 agonist therapy for a minimum of 12 months. The protocol was reviewed and approved by the Albany College of Pharmacy and Health Sciences Institutional Review Board. Potential subjects were identified via a computerized text search of the medication and problem fields of patient electronic medical records (EMRs). Search
RESULTS
The computerized text search of the EMR identified 260 possible study candidates. Of these, 122 patients were excluded because they were not on GLP-1 therapy for at least 12 months or had switched medications in the previous 12 months, 29 patients had an HbA1c <7% or >10%, 19 patients did not have follow-up data, 9 patients were not receiving study drug or were in a clinical trial with the study drug, and 6 patients were excluded for T1DM.
A total of 75 patients met all study criteria.
DISCUSSION
This is the first reported observational study regarding the real-world safety and efficacy of the SGLT-2 inhibitor canagliflozin added to GLP-1 agonist therapy in patients with T2DM. Patients in this study demonstrated significantly reduced HbA1c, weight, and SBP and DBP and a significant increase in mean HDL-C levels with the addition of canagliflozin to baseline GLP-1 therapy.
This study reports a significant yet modest decrease in mean HbA1c of 0.39% with the addition of canagliflozin to
CONCLUSION
In this pre-post observational study, canagliflozin added to GLP-1 therapy was associated with significant reductions in HbA1c and weight, and a significant increase in mean HDL-C levels. Canagliflozin was generally well tolerated with an adverse effect profile consistent with that reported in controlled clinical trials. Overall, canagliflozin appears to be a useful therapeutic add-on to GLP-1 therapy in T2DM patients who are inadequately controlled, allowing for further HbA1c reduction and
DISCLOSURE
Dr. Robert S. Busch, is a member of the Janssen Speakers Bureau, manufacturers of canagliflozin. The other authors have no multiplicity of interest to disclose.
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See accompanying article, p. 1442.