Adding a GLP-1 Agonist to an SGLT2 Inhibitor Could Improve Glycemic Control

Adding the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide to a sodium glucose cotransporter-2 (SGLT2) inhibitor can help to improve glycemic control in patients with inadequately controlled type 2 diabetes, according to the results of a recent study.

There is currently little available evidence on the concomitant use of GLP-1 receptor agonists with SGLT-2 inhibitors. To explore this issue further, researchers conducted a double-blind, parallel-group trial at 51 centers in 6 countries. Three-hundred and two adults with type 2 diabetes and HbA _1c 7% to 10% despite at least 90 days of treatment with SGLT-2 inhibitor were randomly assigned to receive 1 mg subcutaneous semaglutide or placebo once weekly for 30 weeks, after a dose-escalation schedule of 4 weeks of 0.25 mg semaglutide or placebo and 4 weeks of 0.5 mg semaglutide or placebo.

Overall, 294 patients completed the trial and 267 completed treatment. The researchers found that those patients given semaglutide had greater reductions in HbA _1c (estimated treatment difference −1·42) and bodyweight (−3·81 kg) compared with those who received placebo.

In the semaglutide group, 356 adverse events were reported by 104 patients, while 247 were reported by 91 patients in the placebo group. Serious adverse events occurred in 7 patients in the semaglutide group and 20 in the placebo group.

“Adding semaglutide to SGLT-2 inhibitor therapy significantly improves glycemic control and reduces bodyweight in patients with inadequately controlled type 2 diabetes and is generally well tolerated.”

—Michael Potts

Reference:

Zinman B, Bhosekar V, Busch R, et al. Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 diabetes (SUSTAIN 9): a randomised, placebo-controlled trial [published online March 1, 2019]. Lancet Diabetes & Endocrinology. doi:https://doi.org/10.1016/S2213-8587(19)30066-X.