The Powerful Combination of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Diabetes Management
Exciting new research has surfaced, shedding light on the impactful combination of sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in providing added protection against heart and kidney disease in patients with diabetes.1 This groundbreaking study was recently published in The Lancet Diabetes & Endocrinology and was presented at the prestigious 61st European Renal Association Congress in Stockholm, Sweden.
Both classes of medications, SGLT2is, also known as gliflozins, and GLP-1RAs, like Ozempic, have individually demonstrated improvements in cardiovascular outcomes for individuals with diabetes. While initial trials hinted at the potential benefits of using these drugs together to enhance blood glucose control, their combined effects on heart and kidney health were not fully understood.
The SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) conducted a comprehensive review, pooling data from 12 large-scale, placebo-controlled trials of SGLT2is involving over 73,000 patients with diabetes. Among them, over 3,000 were also receiving GLP1-RAs. The findings revealed that the benefits of SGLT2is were apparent regardless of concurrent use of GLP-1RAs.
The meta-analysis showcased a myriad of advantages associated with SGLT2is, including a remarkable 11% reduction in major adverse cardiovascular events (myocardial infarction, stroke, or cardiovascular death) and a substantial 23% decrease in hospitalization for heart failure or cardiovascular death when compared to a placebo, even when combined with GLP-1RAs. Furthermore, the addition of SGLT2is to GLP-1RAs led to a 33% risk reduction in chronic kidney disease progression and nearly 60% deceleration in the annual loss of kidney function. Notably, there were no novel safety concerns identified with the combined use of these medications.
Leading the study, Clinical Associate Professor Brendon Neuen, emphasized the significance of exploring the effects of GLP-1 receptor agonists alongside SGLT2 inhibitors, given the expanding indications for both drug classes. A/Prof Neuen highlighted the independent protective properties of each medication, stating, “SGLT2 inhibitors offer clear benefits in heart failure and kidney disease, while GLP-1 receptor agonists can mitigate the risk of heart attacks, strokes, and kidney disease.” He further underscored the importance of combining these therapies to optimize outcomes for individuals with type 2 diabetes who are suitable candidates for both treatments.
It is well-established that diabetes poses a heightened risk for cardiovascular and kidney diseases, as uncontrolled blood sugar levels can inflict damage on the heart and kidneys’ blood vessels. Many individuals living with diabetes also contend with co-existing cardiovascular or kidney complications, with the prevalence of these conditions escalating in the years following a diabetes diagnosis.
The esteemed SMART-C consortium is co-chaired by A/Prof Brendon Neuen and Prof Hiddo Heerspink, both affiliated with The George Institute for Global Health, underscoring the study’s reputable credentials.
In conclusion, the study’s findings underscore the immense potential of combining SGLT2 inhibitors and GLP-1 receptor agonists in revolutionizing diabetes management. This synergistic approach not only enhances blood glucose control but also offers substantial protection against heart and kidney diseases, crucial comorbidities in individuals with diabetes. As the realm of diabetes therapeutics continues to evolve, the advent of this game-changing medication combination heralds a new era in comprehensive diabetes care.
