Safety and Efficacy of GLP-1 Receptor Agonists and SGLT2 Inhibitors Among Veterans With Type 2 Diabetes

Choosing the best medication regimen for a patient with type 2 diabetes mellitus (T2DM) depends on glycemic control, adherence, adverse effect profile, and comorbid conditions. Two new medication classes, glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), have demonstrated cardiovascular and renal protective properties, creating a new way to care for patients with T2DM.

This study evaluated the safety and efficacy of the combined use of GLP-1 RA and SGLT2i medications in a veteran population with T2DM. We conducted a pre-post, retrospective chart review of patients at the Veterans Affairs Ann Arbor Healthcare System in Michigan who were prescribed both a GLP-1 RA and SGLT2i medications. The primary objective was to determine the effect on hemoglobin A_1c levels (HbA_1c) at 12 weeks when using a GLP-1 RA and SGLT2i in combination.

HbA_1c levels decreased by 1% after 12 weeks of combination therapy from baseline (P < .001), and this reduction was sustained through the duration of the study period. At 26 and 56 weeks of combination therapy, body weight decreased by about 5 kg (5%) from baseline (P < .001). Systolic blood pressure (BP) reduction from baseline reached statistical significance after 26 and 52 weeks of combination therapy (P < .01 and P < .05, respectively). There was no significant change in diastolic BP, serum creatinine, or estimated glomerular filtration rate during the study period.

The combined use of GLP-1 RA and SGLT2i resulted in statistically significant improvement in HbA_1c levels, weight, and systolic BP compared with separate use.