Coexistence of SGLT2 inhibitors and GLP-1 receptor agonists in the treatment of a patient with type 2 diabetes mellitus
Authors:
Piotr Waszczuk
Authors‘ workplace:
Diabetologická ambulancia UNsP Milosrdní bratia, spol. s r. o., Bratislava
Published in:
Diab Obez 2024; 24(1): 41-50
Category:
Overview
The ADA/EASD recommendations are increasing the importance of the use of GLP-1 receptor agonists (GLP1-RA) and SGLT2 inhibitors (SGLT2i) in the treatment of type 2 diabetes mellitus. In patients already treated with GLP1-RA, the addition of SGLT2i with a proven cardiovascular benefit should be considered, or vice versa. The importance of the coexistence of SGLT2i and GLP1-RA, and their potential and additive effects in treatment has been pointed out by several studies, and addressed by several authors in their papers. The SUSTAIN 9 study and the ADWARD 10 study, both randomized, double-blind, placebo-controlled, multicentre and international trials, point to the significant metabolic effects of the combination of GLP1-RA and an SGLT2i and their importance in the treatment of type 2 diabetes mellitus. The coexistence of SGLT2 and GLP1-RA, and the complementary mechanisms of action of SGLT2i and GLP1-RA, yield cardio-renal-metabolic effects in the treatment of patients with type 2 diabetes mellitus. The current indication limitations expand the possibilities for the use of GLP1-RA and SGLT2i in therapeutic modalities. The coexistence of SGLT2i and GLP1-RA for outpatient practice is schematically illustrated and described in a step-by-step time sequence in the pictorial appendix. The combination of SGLT2i and GLP1-RA in fixed combination with basal insulin provides the possibility of influencing the pathophysiological mechanisms of the so-called “ominous octet”.
Keywords:
fixed combination – basal insulin – ADWARD 10 – cardio-renal-metabolic effects – coexistence of SGLT2i and GLP-1 RA – SUSTAIN 9
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