Glucagon‐like peptide‐1 agonists combined with sodium‐glucose cotransporter‐2 inhibitors reduce weight in type 1 diabetes

Ebaa Al‐Ozairi, Mohammad Irshad, Etab Taghadom, Litty Sojan, Jumana Al Kandari, Dherar Alroudhan, Carel W. le Roux

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Abstract

Objective: This study evaluated whether adding sodium-glucose cotransporter-2 inhibitors (SGLT2i) and/or glucagon-like peptide-1 receptor agonists (GLP1-RA) to insulin reduced weight and glycemia in people with type 1 diabetes. Methods: This retrospective analysis of electronic health records evaluated 296 people with type 1 diabetes over 12 months after medications were first prescribed. Four groups were defined: control n = 80, SGLT2i n = 94, GLP1-RA n = 82, and combination of drugs (Combo) n = 40. We measured changes at 1 year in weight and glycated hemoglobin (HbA1c). Results: The control group did not have changes in weight or glycemic control. The mean (SD) percentage weight loss after 12 months was 4.4% (6.0%), 8.2% (8.5%), and 9.0% (8.4%) in the SGLT2i, GLP1-RA, and Combo groups, respectively (p < 0.001). The Combo group lost the most weight (p < 0.001). The HbA1c reduction was 0.4% (0.7%), 0.3% (0.7%), and 0.6% (0.8%) in the SGLT2i, GLP1-RA, and Combo groups, respectively (p < 0.001). The Combo group had the biggest improvements in glycemic control and total and low-density lipoprotein cholesterol compared with baseline (all p < 0.01). Severe adverse events were similar between all the groups, with no increased risk of diabetic ketoacidosis. Conclusions: The SGLT2i and GLP1-RA agents on their own improved body weight and glycemia, but combining the medications resulted in more weight loss. Treatment intensification appears to result in benefits with no difference in severe adverse events.

Original languageEnglish
Pages (from-to)716-723
Number of pages8
JournalObesity
Volume31
Issue number3
Early online date22 Feb 2023
DOIs
Publication statusPublished (in print/issue) - Mar 2023

Bibliographical note

Funding information:
Kuwait Foundation for the Advisement of Sciences, Kuwait; Ministry of Health, Kuwait

Funding Information:
ClR reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, and Boehringer Ingelheim. ClR is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. He was the chief medical officer and director of the Medical Device Division of Keyron in 2011. Both of these were unremunerated positions. He continues to provide scientific advice to Keyron for no remuneration. The other authors declared no conflict of interest.

Funding Information:
The authors thank the staff members of the DAFNE unit who have helped in the retrospective data collection and Dasman Diabetes Institute for administrative support, in addition to the clinical laboratory service at Dasman Diabetes Institute.

Publisher Copyright:
© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.

Funding Information:
ClR reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, and Boehringer Ingelheim. ClR is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. He was the chief medical officer and director of the Medical Device Division of Keyron in 2011. Both of these were unremunerated positions. He continues to provide scientific advice to Keyron for no remuneration. The other authors declared no conflict of interest.

Funding Information:
The authors thank the staff members of the DAFNE unit who have helped in the retrospective data collection and Dasman Diabetes Institute for administrative support, in addition to the clinical laboratory service at Dasman Diabetes Institute.

Publisher Copyright:
© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.

Keywords

  • Humans
  • Hypoglycemic Agents/therapeutic use
  • Diabetes Mellitus, Type 2/drug therapy
  • Diabetes Mellitus, Type 1
  • Sodium-Glucose Transporter 2 Inhibitors/pharmacology
  • Glycated Hemoglobin
  • Retrospective Studies
  • Glucagon-Like Peptide-1 Receptor/agonists
  • Glucagon-Like Peptide 1/therapeutic use
  • Weight Loss
  • Glucose
  • Sodium

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