Skip to main content
Erschienen in:

08.08.2023

Does GLP-RA Plus an SGLT2 Inhibitor Yield Greater Weight Loss in Patients with Obesity and Diabetes than Monotherapy?

verfasst von: Caraline Watkins, Zoe Schilling, Kevin Kawalec, Darrell Hulisz

Erschienen in: Current Cardiovascular Risk Reports | Ausgabe 9/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

With the rate of obesity increasing in the USA, effective and safe medications for weight loss are more important than ever in patient care. Glucagon-like peptide 1 receptor agonists (GLP-RA) and sodium-glucose co-transporter 2 (SGLT2) inhibitors are two medication for type 2 diabetes that have shown benefit in randomized control trials for not just diabetes but weight loss and lowering cardiovascular and renal risks. These novel medications have continued to show benefits in weight loss in randomized control trials. A literature review was conducted to determine the impact of GLP-RAs and SGLT2 inhibitors as combination therapy for weight loss in patients with diabetes. Another purpose of this review was to define a specific patient population that would potentially benefit from both a GLP-RA and SGLT2 for weight loss.

Recent Findings

Several monotherapy trials for GLP-RA and SGLT2 inhibitors have shown positive weight loss reductions along with hemoglobin A1c reductions (HbA1c) and other metabolic parameters. Several studies of combination therapy with a GLP-RA plus an SGLT2 inhibitor have shown greater weight loss than just monotherapy with either agent.

Summary

There are many promising studies that show significant weight loss from monotherapy and combination therapy in patients with type 2 diabetes. Further randomized control trials are needed to identify which patients would benefit most from combination therapy.
Literatur
2.
Zurück zum Zitat Holman R. Metformin as first choice in oral diabetes treatment: the UKPDS experience. J Annu Diabetol Hotel Dieu. 2007;13–20 Holman R. Metformin as first choice in oral diabetes treatment: the UKPDS experience. J Annu Diabetol Hotel Dieu. 2007;13–20
8•.
Zurück zum Zitat Ali AM, Martinez R, Al-Jobori H, et al. Combination therapy with canagliflozin plus liraglutide exerts additive effect on weight loss, but not on HbA1c, in patients with type 2 diabetes. Diabetes Care. 2020;43(6):1234–41. https://doi.org/10.2337/dc18-2460. Ali et al. evaluated the effect of combination GLP-RA and SGTL2 directly on weight loss. Patients were evaluated for 16 weeks of combination therapy with a primary endpoint of mean decrease from baseline in total body weight. There was a significant decrease in weight with those taking combination therapy versus placebo (monotherapy).CrossRefPubMedPubMedCentral Ali AM, Martinez R, Al-Jobori H, et al. Combination therapy with canagliflozin plus liraglutide exerts additive effect on weight loss, but not on HbA1c, in patients with type 2 diabetes. Diabetes Care. 2020;43(6):1234–41. https://​doi.​org/​10.​2337/​dc18-2460. Ali et al. evaluated the effect of combination GLP-RA and SGTL2 directly on weight loss. Patients were evaluated for 16 weeks of combination therapy with a primary endpoint of mean decrease from baseline in total body weight. There was a significant decrease in weight with those taking combination therapy versus placebo (monotherapy).CrossRefPubMedPubMedCentral
9•.
Zurück zum Zitat Díaz-Trastoy O, Villar-Taibo R, Sifontes-Dubón M, Mozo-Peñalver H, Bernabeu-Morón I, Cabezas-Agrícola JM, et al. GLP1 receptor agonist and SGLT2 inhibitor combination: an effective approach in real world clinical Practice. Clin. Ther. 2020;42(2):e1–e12. https://doi.org/10.1016/j.clinthera.2019.12.012. Díaz et al is a retrospective review on patients taking combination therapy not looking at one specific agent which makes it more generalizable. Those who were on combination therapy did have a significant reduction in HbA1c and had mean weight loss of 3.5 kg and 40% achieved a weight loss of 5% or greater.CrossRefPubMed Díaz-Trastoy O, Villar-Taibo R, Sifontes-Dubón M, Mozo-Peñalver H, Bernabeu-Morón I, Cabezas-Agrícola JM, et al. GLP1 receptor agonist and SGLT2 inhibitor combination: an effective approach in real world clinical Practice. Clin. Ther. 2020;42(2):e1–e12. https://​doi.​org/​10.​1016/​j.​clinthera.​2019.​12.​012. Díaz et al is a retrospective review on patients taking combination therapy not looking at one specific agent which makes it more generalizable. Those who were on combination therapy did have a significant reduction in HbA1c and had mean weight loss of 3.5 kg and 40% achieved a weight loss of 5% or greater.CrossRefPubMed
12.
Zurück zum Zitat Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials [published correction appears in Lancet Diabetes Endocrinol. 2020 Mar;8(3):e2]. Lancet Diabetes Endocrinol. 2019;7(10):776–85. https://doi.org/10.1016/S2213-8587(19)30249-9.CrossRefPubMed Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials [published correction appears in Lancet Diabetes Endocrinol. 2020 Mar;8(3):e2]. Lancet Diabetes Endocrinol. 2019;7(10):776–85. https://​doi.​org/​10.​1016/​S2213-8587(19)30249-9.CrossRefPubMed
13.
Zurück zum Zitat Trulicity® (dulaglutide) [package insert]. Indianapolis, IN. Eli and Lily and Company; 2017. Trulicity® (dulaglutide) [package insert]. Indianapolis, IN. Eli and Lily and Company; 2017.
14.
Zurück zum Zitat Byetta® (exenatide) [package insert]. San Diego, CA. Amylin Pharmaceuticals; 2009. Byetta® (exenatide) [package insert]. San Diego, CA. Amylin Pharmaceuticals; 2009.
15.
Zurück zum Zitat Bydureon® (exenatide) [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals LP; 2017 Bydureon® (exenatide) [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals LP; 2017
16.
Zurück zum Zitat Bydureon BCise® (exenetide ER) [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals LP; 2017 Bydureon BCise® (exenetide ER) [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals LP; 2017
17.
Zurück zum Zitat Victoza® (liraglutide) [package insert] Bagsvaerd, Denmark. Novo Nordisk A/S; 2017 Victoza® (liraglutide) [package insert] Bagsvaerd, Denmark. Novo Nordisk A/S; 2017
18.
Zurück zum Zitat Saxenda® (liraglutide) [package insert] Bagsvaerd, Denmark. Novo Nordisk A/S; 2014 Saxenda® (liraglutide) [package insert] Bagsvaerd, Denmark. Novo Nordisk A/S; 2014
19.
Zurück zum Zitat Adylxin® (lixisenatide) [package insert] Bridgewater, NJ. Sanofi. 2021 Adylxin® (lixisenatide) [package insert] Bridgewater, NJ. Sanofi. 2021
20.
Zurück zum Zitat Ozempic® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2017 Ozempic® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2017
21.
Zurück zum Zitat Wegovy® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2021 Wegovy® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2021
22.
Zurück zum Zitat Rybelsus® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2019 Rybelsus® (semaglutide) [package insert] Bagsvaerd, Denmakr. Novo Nordisk A/S; 2019
23.
Zurück zum Zitat Invokana® (canagloflozin) [package insert] Titusville, NJ. Janssen Pharmaceuticals; 2013 Invokana® (canagloflozin) [package insert] Titusville, NJ. Janssen Pharmaceuticals; 2013
24.
Zurück zum Zitat Farxiga® (dapagliflozin) [package insert] Princeton, NJ. Bristol-Myers Scquibb Company; 2014 Farxiga® (dapagliflozin) [package insert] Princeton, NJ. Bristol-Myers Scquibb Company; 2014
25.
Zurück zum Zitat Jardiance® (empagliflozin) [package insert] Indianapolis, IN. Eli Lily and Company; 2016 Jardiance® (empagliflozin) [package insert] Indianapolis, IN. Eli Lily and Company; 2016
26.
Zurück zum Zitat Steglatro® (ertugliflozin) [package insert] Whitehouse Station, NJ. Merck & Co Inc.; 2017 Steglatro® (ertugliflozin) [package insert] Whitehouse Station, NJ. Merck & Co Inc.; 2017
33.
Zurück zum Zitat Leiter LA, Yoon KH, Arias P, et al. Canagliflozin provides durable glycemic improvements and body weight reduction over 104 weeks versus glimepiride in patients with type 2 diabetes on metformin: a randomized, double-blind, phase 3 study. Diabetes Care. 2015;38(3):355–64. https://doi.org/10.2337/dc13-2762.CrossRefPubMed Leiter LA, Yoon KH, Arias P, et al. Canagliflozin provides durable glycemic improvements and body weight reduction over 104 weeks versus glimepiride in patients with type 2 diabetes on metformin: a randomized, double-blind, phase 3 study. Diabetes Care. 2015;38(3):355–64. https://​doi.​org/​10.​2337/​dc13-2762.CrossRefPubMed
Metadaten
Titel
Does GLP-RA Plus an SGLT2 Inhibitor Yield Greater Weight Loss in Patients with Obesity and Diabetes than Monotherapy?
verfasst von
Caraline Watkins
Zoe Schilling
Kevin Kawalec
Darrell Hulisz
Publikationsdatum
08.08.2023
Verlag
Springer US
Erschienen in
Current Cardiovascular Risk Reports / Ausgabe 9/2023
Print ISSN: 1932-9520
Elektronische ISSN: 1932-9563
DOI
https://doi.org/10.1007/s12170-023-00724-3

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Kardiologie

Koronare Herzkrankheit: Das waren die Top-Studien 2024

Zum Thema Koronare Herzkrankheit gab es 2024 wichtige neue Studien. Beleuchtet wurden darin unter anderem der Stellenwert von Betablockern nach Herzinfarkt, neue Optionen für eine Lipidsenkung sowie die Therapie bei infarktbedingtem kardiogenem Schock.

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Kaffeegenuss sicher bei Vorhofflimmern

Menschen mit Vorhofflimmern fürchten oft, Kaffee könnte schlecht für ihr Herz sein. Solche Ängste sind offenbar unbegründet: Zwei Schweizer Untersuchungen deuten sogar auf eine reduzierte Rate von kardiovaskulären Ereignissen unter Kaffeetrinkern.

Mit jedem Defibrillationsversuch sinkt die Überlebenschance

Wie wirkt es sich auf die Prognose aus, wenn bei Herzstillstand einmal, zweimal oder gar 29 Mal geschockt werden muss? Laut einer aktuellen Studie besteht ein deutlicher Zusammenhang zwischen der Zahl der Defibrillationsversuche und den Überlebenschancen.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.