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.
Por:
Carretero Gómez J, Arévalo Lorido JC, Gómez Huelgas R, García de Lucas D, Mateos Polo L, Varela Aguilar JM, Segui J and Ena J
Publicada:
1 abr 2019
Ahead of Print:
8 sep 2018
Resumen:
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/m(2). 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/m(2); 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.
Filiaciones:
Carretero Gómez J:
Internal Medicine Department, Zafra Hospital, Ctra Badajoz-Granada, s/n, 06300 Zafra, Badajoz, Spain
Arévalo Lorido JC:
Internal Medicine Department, Zafra Hospital, Ctra Badajoz-Granada, s/n, 06300 Zafra, Badajoz, Spain
Gómez Huelgas R:
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
García de Lucas D:
Internal Medicine Department, Costa del Sol Hospital, Autovía A7, Km 187, Marbella, Málaga, Spain
Mateos Polo L:
Internal Medicine Department, University Hospital of Salamanca, Paseo de San Vicente 182, Salamanca, Spain
Varela Aguilar JM:
Internal Medicine Department, Biomedical Research Centre Network for Epidemiology and Public Health, Virgen del Rocío University Hospital, Av. Manuel Siurot, s/n, Sevilla, Spain
Segui J:
Internal Medicine Department, San Juan de Alicante University Hospital, Ctra Alicante-Valencia, s/n, San Juan, Alicante, Spain
:
Internal Medicine Department, Marina Baixa Hospital, Avda. Alcalde En Jaume Botella Mayor, s/n, La Vila Joiosa. Alicante, Spain
|