Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis

• Published in: Scientific reports Vol. 9; no. 1; pp. 19351 - 8
• Main Authors: Castellana, Marco, Cignarelli, Angelo, Brescia, Francesco, Perrini, Sebastio, Natalicchio, Annalisa, Laviola, Luigi, Giorgino, Francesco
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 18-12-2019; Nature Publishing Group
• Subjects: 692/163/2743/137/773; 692/699/2743/137/773; Blood pressure; Blood Pressure - drug effects; Body weight; Body Weight - drug effects; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Glucagon-Like Peptide-1 Receptor - agonists; Glycated Hemoglobin - metabolism; Health risk assessment; Health risks; Humanities and Social Sciences; Humans; Lipids; Meta-analysis; multidisciplinary; Randomized Controlled Trials as Topic; Risk factors; Science; Science (multidisciplinary); Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - pharmacology; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Systole - drug effects; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-55524-w

GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) have been associated with improved glycemic control, body weight loss and favorable changes in cardiovascular risk factors and outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of the addition of GLP-1RA to SGLT2i in patients with type 2 diabetes mellitus and inadequate glycemic control. Six databases were searched until March 2019. Randomized controlled trials (RCT) with a follow-up of at least 24 weeks reporting on HbA1c, body weight, systolic blood pressure, lipids, achievement of HbA1c < 7%, requirement of rescue therapy due to hyperglycemia and hypoglycemic events were selected. Four RCTs were included. Compared to SGLT2i, the GLP-1RA/SGLT2i combination was associated with greater reduction in HbA1c (−0.74%), body weight (−1.61 kg), and systolic blood pressure (−3.32 mmHg). A higher number of patients achieved HbA1c < 7% (RR = 2.15), with a lower requirement of rescue therapy (RR = 0.37) and similar incidence of hypoglycemia. Reductions in total and LDL cholesterol were found. The present review supports treatment intensification with GLP-1RA in uncontrolled type 2 diabetes on SGLT2i. This drug regimen could provide improved HbA1c control, together with enhanced weight loss and blood pressure and lipids control.