A recent study provided real-world data on the clinical benefits of a combination of glucagon-like peptide-1 receptor agonists (GLP-1ra) and sodium-glucose cotransporter 2 (SGLT2i) in obese geriatric population affected with type-2 diabetes mellitus (T2DM) having inadequate glycemic control.  Elderly obese T2DM patients who were treated with combination of GLP-1ra and SGLT2i achieved better glycemic control, along with significant reduction in body weight and systolic blood pressure (SBP) as compared to those who were treated with single component of the combination.

The benefits of the combination of GLP-1ra and SGLT2i are well-established clinically, but there is very limited real-world data with regards to the use of this combination in the geriatric population. This study was therefore conducted to provide real-world efficacy and safety data on SGLT2 inhibitors and GLP-1ra combination therapy in geriatric population (>65 years of age).

The findings for this observational, prospective, multicenter study were derived from the clinical practices at the internal medicine outpatient departments at various hospitals in Canada. Patients were stratified as per the tertiles of baseline glycated hemoglobin (HbA1c) levels: 1st tertile; HbA1c ≤7.6%, 2nd tertile; HbA1c >7.6% ≤8.4%, 3rd tertile >8.4%. Patients were also stratified as per their treatment strategy: adding GLP-1ra to previous SGLT2i treatment, adding SGLT2i to previous GLP-1ra treatment, or initiating both the medications together. Patients were followed for the change in HbA1c at 3 and 6 months. The important secondary outcomes comprised of changes in body weight, SBP and diastolic blood pressure, and the proportion of patients who achieved HbA1c levels <7%, BMI <30 kg/m2 and BP <130/80 mmHg or HbA1c levels <7% and weight loss greater than 5% without hypoglycemia, and incidence of hypoglycemia.

The study population comprised of 113 patients with baseline HbA1c levels greater than 7% (males; 65.5%, age; 65-80 years, mean age; 70.4 years). The body mass index (BMI) was 36.5 kg/m2 and the baseline HbA1c level was 8.0%. At the 6-month follow up, there was a significant reduction in HbA1c levels (–1.1%; p<0.0001), BMI (–2.1 kg/m2; p<0.00003) and SBP (–13 mmHg; p<0.000005). Patients in the highest tertile of the baseline HbA1c levels had greater improvements in HbA1c levels (p<0.0001), weight (p<0.0001) and quality-of-life scores (p<0.0001). Also, patients who started both drugs simultaneously (p<0.0001) had greatest reduction on HbA1c levels and weight. The second greatest reduction was evident in patient for whom GLP-1ra was added to previous treatment with an SGLT2i (p<0.0001). Decrease in SBP in patients in whom an SGLT2i was added to previous GLP-1ra treatment (p<0.0001) was also worth noting. Of the entire study population, 34.3% achieved the combined endpoint of HbA1c levels <7% and weight loss ≥5% without hypoglycemia.

The dropout and hypoglycemia rates were minimal, and treatment was well tolerated. The findings from this study are a value addition that strengthens the existing data on the use of this combination in geriatric population.

Can J Diabetes. 2019; 43:186–192.