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“Which one should I choose, a glucagon-like peptide-1 receptor agonist or a sodium−glucose cotransporter 2 inhibitor? Or maybe both?”

Published:December 27, 2021DOI:https://doi.org/10.1016/j.ejim.2021.12.010
      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 [
      • 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.
      ]. 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 [
      • 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).
      ]. 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 [
      • 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.
      ]. 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 [
      • 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.
      ,
      • 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.
      ].

      Keywords

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