SGLT2 inhibitors as add on therapy in type 2 diabetes: a real world study

Abstract

BackgroundType 2 diabetes mellitus (T2DM) is a progressive chronic disease associated with severe microvascular and macrovascular complications.Our aim is to assess the real world effectiveness of SGT" inhibitors in achieving metabolic therapeutic goals.MethodsA retrospective, observational study. Inclusion criteria for patients were a previous diagnosis of type 2 diabetes mellitus, age > 18 years, patients receiving either dapagliflozin 10 mg and/or canagliflozin 300 mg. We excluded pregnant patients, patients with type 1 diabetes mellitus and acute metabolic complications of diabetes. Patients included in the analysis were enrolled in a health plan at least 6 months prior to the index date (baseline period) and in the 6 months following the index date (follow-up period). Achievement of glycated hemoglobin goals were established as <7%.ResultsWe screened 2870 Mexican patients; 288 (10.03% received SGLT2 inhibitors). Mean age for both groups of patients was 57.68 ± 11.06 years. The dapagliflozin control rate was 19.56% and the canagliflozin control rate 18.96%. Monotherapy with SGLT2 inhibitors was used in 21 patients (6.25%). Overall HbA1c goals were met in 56 patients (19.44%) with similar results with dapagliflozin or canagliflozin. The combination of SGLT2 inhibitors and sulfonylureas had the highest control rate (30.30%) compared to other regimens. Monotherapy was present in 6.25%. Insulin requirement was associated with poor control (2.8% vs. 18.05%, P < 0.05, 95% CI [0.07, 0.84]). Combination therapy with DPP4 inhibitors was associated with better control (P < 0.05, 95% CI, [1.10, 3.92]).ConclusionNo difference between the drugs was observed. Real-world effectiveness data of SGLT2 inhibitors show that the percentage of patients reaching metabolic goals is low. SLGT2 inhibitors were used more frequently as combined therapy.

Comparative Efficacy and Safety Among Sodium-glucose Cotransporter-2 Inhibitors in Type 2 Diabetes – Results from a Retrospective Single-centre Study

“…7 The short-term real-world setting (n=9), had also given similar results. 8 A study by Tamez-Perez et al 2013 on SGLT2i showed an average HbA1c reduction of 1.0% for the C group and 1.1% for the D group, 9 while Liakos et al 2014 observed a mean reduction of 0.7% in group E, 10 which is consistent with the results of our study. Real-world evidence from India has also shown reduction of 1.0% in mean HbA1c after 3 months of SGLT2i therapy.…”

“…15–17 The effect of C, D and E on body weight in our study is consistent with previous results showing similar weight loss (C, 1.7; D, 2.1; E, 3.7 kg) from baseline. 9 The reductions in BMI also paralleled the weight changes (1.0 kg/m 2 with C, 0.5 kg/m 2 with D and 2.1 kg/m 2 with E) in our study. Davies et al observed an approximately similar reduction in BMI with C (100 mg).…”

Effect of Canagliflozin on endothelial function in diabetic patients with suspected coronary artery disease: retrospective preliminary pilot study

“…In the experimental animal studies, SGLT2 showed anti-atherosclerotic effects through anti-oxidant effects 6) . Further, SGLT2 and DPP4 showed synergic effects on the anti-atherosclerotic effect in the experimental study 16,17) , and the preliminary clinical study [18][19][20] . Intestinal sodium glucose cotransporter-1 inhibition was reported to enhance glucagon-like peptide-1 (GLP-1) secretion in normal and diabetic rodents 21) .…”

“…Since SGLT2 are relatively new oral hypoglycemic agents on the clinical settings, there are few studies on the effect of SGLT2 and the synergic effect of DPP4 and SGLT2 in humans. In the real world, SGLT2 is frequently added to DM patients similar to this study 20) . And preliminary clinical study showed that the combination therapies of DPP4 and SGLT2 seem to be effective in the treatment of patients with type 2 DM 19,20) .…”

“…In the real world, SGLT2 is frequently added to DM patients similar to this study 20) . And preliminary clinical study showed that the combination therapies of DPP4 and SGLT2 seem to be effective in the treatment of patients with type 2 DM 19,20) . These findings are similar to our results.…”