Glucagon‐like peptide‐1 agonists combined with sodium‐glucose cotransporter‐2 inhibitors reduce weight in type 1 diabetes

Abstract

ObjectiveThis study evaluated whether adding sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) and/or glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) to insulin reduced weight and glycemia in people with type 1 diabetes.MethodsThis retrospective analysis of electronic health records evaluated 296 people with type 1 diabetes over 12 months after medications were first prescribed. Four groups were defined: control n = 80, SGLT2i n = 94, GLP1‐RA n = 82, and combination of drugs (Combo) n = 40. We measured changes at 1 year in weight and glycated hemoglobin (HbA1c).ResultsThe control group did not have changes in weight or glycemic control. The mean (SD) percentage weight loss after 12 months was 4.4% (6.0%), 8.2% (8.5%), and 9.0% (8.4%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group lost the most weight (p < 0.001). The HbA1c reduction was 0.4% (0.7%), 0.3% (0.7%), and 0.6% (0.8%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group had the biggest improvements in glycemic control and total and low‐density lipoprotein cholesterol compared with baseline (all p < 0.01). Severe adverse events were similar between all the groups, with no increased risk of diabetic ketoacidosis.ConclusionsThe SGLT2i and GLP1‐RA agents on their own improved body weight and glycemia, but combining the medications resulted in more weight loss. Treatment intensification appears to result in benefits with no difference in severe adverse events.

Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

“…Pharmacotherapies including glucagon-like peptide 1 agonists, SGLT2i, and other antidiabetic medications indirectly promote weight loss while also providing metabolic benefits. 38) …”

The emergence of obesity in type 1 diabetes

“…More recently, a 52-week study ( n = 76) yielded comparable results for daily insulin dose and HbA1c but indicated a more substantial reduction in body weight (−5.1 kg) [ 76 ]. In another study, combining both GLP1-RA and SGLT2 inhibitor resulted in the greatest percentage of weight loss (9.0%) compared to a single prescription, after 12 months [ 77 ]. This combination improved HbA1c, total cholesterol, and LDL-cholesterol while remaining safe from DKA and hypoglycaemia [ 77 ].…”

“…In another study, combining both GLP1-RA and SGLT2 inhibitor resulted in the greatest percentage of weight loss (9.0%) compared to a single prescription, after 12 months [ 77 ]. This combination improved HbA1c, total cholesterol, and LDL-cholesterol while remaining safe from DKA and hypoglycaemia [ 77 ]. Notably, the implementation of a structured risk prevention programme and sick-day guidance were applied to all enroled patients, [ 77 ] highlighting the importance of investing in patient education and the provision of adaptable care.…”

Sodium–glucose cotransporter 2 inhibitors in horses—Magic bullet or latest fad?

“…30 This combination pharmacotherapy achieves more significant reductions in bodyweight and fat mass compared with monotherapy. 32,33 The efficacy and safety of GLP-1 agonists alone or in combination with SGLT2i have not been investigated in horses.…”

“…Co‐administration of SGLT2i with drugs that reduce food intake (e.g., glucagon‐like peptide 1 [GLP‐1] agonists) is now commonplace in human medicine to mitigate the mechanisms that counteract weight loss with long‐term use of SGLT2i 30 . This combination pharmacotherapy achieves more significant reductions in bodyweight and fat mass compared with monotherapy 32,33 . The efficacy and safety of GLP‐1 agonists alone or in combination with SGLT2i have not been investigated in horses.…”