Objective: GLP-1 receptor agonists and SGLT2 inhibitors improve glycemic control, body weight, blood pressure and albuminuria by different pathways. However, their combination is not endorsed by ADA-EASD guidelines, and available data are scarce. Our objective in this open observational study was to elucidate the effect of added Dulaglutide in obese type 2 diabetic patients previously treated with Empagliflozin but insufficiently controlled.
Methods: Dulaglutide 1.5 mg/week was added to the treatment of 20 type 2 diabetic patients with BMI >30 kg/m2 previously treated with Empagliflozin 10 mg/day for at least 3 months but having HbA1C >7%. They were re-evaluated after 36 months without additional medication changes, except for insulin dosage adjustments and iDPP4 discontinuation. Besides clinical routine, 24 h. ABPM were performed before and after. Stats were performed by two-tailed paired t-test, *meaning P<0.05. Values are given as mean±S.D.
Results: Age was 49±11 and diabetes duration 8±3 years. 53% were women. Baseline BMI was 34.9±2.5 kg/m2; ABPM: Awake, BP 131±8/85±8 mmHg, HR 74±10 bpm; Sleep, 127±8/78±10 mmHg, 69±10 lpm. Fasting glycemia was 167±46 mg/dl, HbA1C 8.0±0.6%, urate 6.9±1.4 mg/dl, Cr 0.91±0.17 mg/dl, GFR (CKD-EPI estimation) 87.1±16.8 ml/min/1.73 m2, Albuminuria 291±268 mg/gr Cr; median 232, IQR 23-460. At follow-up there were no withdrawals due to side effects, one patient was lost to follow-up and 16% reported mild nausea and/or diarrhoea. Body weight change was −4.0±2.6* kg, BMI −1.37±0.83* kg/m2. ABPM: Awake SBP −4±4*, DBP −1±3 mmHg, HR 1±4 bpm; Sleep, SBP −6±5*, DBP −4±6* mmHg, HR +2±7 bpm. Fasting glycemia change −41±23* mg/dl; HbA1C −1.1±0.6* %, urate −0.12±0.24* mg/dl; Cr −0.04±0.11 mg/dl, GFR +1.9±7.3 ml/min/1.73 m2, albuminuria −71±105* mg/gr Cr (−29±31%).
Conclusions: Dulaglutide added on Empagliflozin in obese type 2 diabetic patients was well tolerated and effective for glycemic control, body weight, blood pressure (particularly nocturnal) and albuminuria.
20 - 23 May 2017
European Society of Endocrinology