In a recently published narrative review article authored by Gomez-Huelgas and colleagues,
authors propose an interesting treatment algorithm, based on the cardiovascular and
renal protection offered by newer antidiabetic drug classes [
[1]
]. According to the consensus report published by the American Diabetes Association
and the European Association for the Study of Diabetes in 2020, glucagon-like peptide
1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 (SGLT2) inhibitors
are prioritized for the treatment of patients with type 2 diabetes mellitus (T2DM)
to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure
(HF), cardiovascular death, or chronic kidney disease (CKD) development and progression,
regardless of glycemic control [
- Gómez-Huelgas R.
- Sanz-Cánovas J.
- Cobos-Palacios L.
- López-Sampalo A.
- Pérez-Belmonte L.M.
Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors
for cardiovascular and renal protection: a treatment approach far beyond their glucose-lowering
effect.
Eur J Intern Med. 2021; S0953-6205 (Epub ahead of printPMID: 34799233): 00383-00386https://doi.org/10.1016/j.ejim.2021.11.008
[2]
]. SGLT-2 inhibitors appear to be superior to GLP-1RAs in terms of reduction of mortality
and hospitalization for HF, while, GLP-1RAs are superior to SGLT-2 inhibitors in preventing
non-fatal stroke [
- Buse J.B.
- Wexler D.J.
- Tsapas A.
- Rossing P.
- Mingrone G.
- Mathieu C.
- D'Alessio D.A.
- Davies M.J.
Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American
diabetes association (ADA) and the European association for the study of diabetes
(EASD).
Diabetes Care. 2020; 43 (Epub 2019 Dec 19. Erratum in: Diabetes Care. 2020 Jul;43(7):1670. PMID: 31857443;
PMCID: PMC6971782): 487-493https://doi.org/10.2337/dci19-0066
[3]
]. A question that inevitably arises is whether these drug classes can be combined
in clinical practice, and if there is a synergistic cardio-protective effect with
such a combination. Former meta-analyses have demonstrated that SGLT-2 inhibitor/GLP-1RA
combination therapy decreases glycated hemoglobin, body weight and blood pressure
levels more than monotherapy either with a SGLT-2 inhibitor or a GLP-1RA [
- Palmer S.C.
- Tendal B.
- Mustafa R.A.
- Vandvik P.O.
- Li S.
- Hao Q.
- Tunnicliffe D.
- Ruospo M.
- Natale P.
- Saglimbene V.
- Nicolucci A.
- Johnson D.W.
- Tonelli M.
- Rossi M.C.
- Badve S.V.
- Cho Y.
- Nadeau-Fredette A.C.
- Burke M.
- Faruque L.I.
- Lloyd A.
- Ahmad N.
- Liu Y.
- Tiv S.
- Millard T.
- Gagliardi L.
- Kolanu N.
- Barmanray R.D.
- McMorrow R.
- Raygoza Cortez A.K.
- White H.
- Chen X.
- Zhou X.
- Liu J.
- Rodríguez A.F.
- González-Colmenero A.D.
- Wang Y.
- Li L.
- Sutanto S.
- Solis R.C.
- Díaz González-Colmenero F.
- Rodriguez-Gutierrez R.
- Walsh M.
- Guyatt G.
- Strippoli G.F.M
Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1
(GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis
of randomised controlled trials.
[4]
,
- Mantsiou C.
- Karagiannis T.
- Kakotrichi P.
- Malandris K.
- Avgerinos I.
- Liakos A.
- Tsapas A.
- Bekiari E.
Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors
as combination therapy for type 2 diabetes: a systematic review and meta-analysis.
Diabetes Obes Metab. 2020; 22 (Epub 2020 Jul 14PMID: 32476254): 1857-1868https://doi.org/10.1111/dom.14108
[5]
].- Patoulias D.
- Stavropoulos K.
- Imprialos K.
- Katsimardou A.
- Kalogirou M.S.
- Koutsampasopoulos K.
- Zografou I.
- Papadopoulos C.
- Karagiannis A.
- Doumas M.
Glycemic efficacy and safety of glucagon-like peptide-1 receptor agonist on top of
sodium-glucose co-transporter-2 inhibitor treatment compared to sodium-glucose co-transporter-2
inhibitor alone: a systematic review and meta-analysis of randomized controlled trials.
Diabetes Res Clin Pract. 2019; 158 (Epub 2019 Nov 13PMID: 31733280)107927https://doi.org/10.1016/j.diabres.2019.107927
Keywords
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References
- Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors for cardiovascular and renal protection: a treatment approach far beyond their glucose-lowering effect.Eur J Intern Med. 2021; S0953-6205 (Epub ahead of printPMID: 34799233): 00383-00386https://doi.org/10.1016/j.ejim.2021.11.008
- Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American diabetes association (ADA) and the European association for the study of diabetes (EASD).Diabetes Care. 2020; 43 (Epub 2019 Dec 19. Erratum in: Diabetes Care. 2020 Jul;43(7):1670. PMID: 31857443; PMCID: PMC6971782): 487-493https://doi.org/10.2337/dci19-0066
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- Glycemic efficacy and safety of glucagon-like peptide-1 receptor agonist on top of sodium-glucose co-transporter-2 inhibitor treatment compared to sodium-glucose co-transporter-2 inhibitor alone: a systematic review and meta-analysis of randomized controlled trials.Diabetes Res Clin Pract. 2019; 158 (Epub 2019 Nov 13PMID: 31733280)107927https://doi.org/10.1016/j.diabres.2019.107927
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Article info
Publication history
Published online: December 27, 2021
Accepted:
December 13,
2021
Received in revised form:
December 7,
2021
Received:
November 29,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
