Delhi: Recommendations on SGLT-2 Inhibitors and GLP-1 Receptor Agonists

An international panel including patients, clinicians, and methodologies has released risk-stratified recommendations concerning the use of SGLT-2 inhibitors or GLP-1 receptor agonists in adults with type 2 diabetes.

Clinical decisions about the treatment of type 2 diabetes have been led by glycaemic control for decades. SGLT-2 inhibitors and GLP-1 receptor agonists are traditionally used in people with elevated glucose levels after metformin treatment. This has changed through trials demonstrating atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) benefits independent of medications' glucose-lowering potential.

The recommendations were based on the results from a linked systematic review and network meta-analysis (764 randomized trials included 421,346 participants) of benefits and harms.

Risk-Stratified Recommendations

• Three or fewer cardiovascular risk factors without established CVD or CKD: Weak recommendation against starting SGLT-2 inhibitors or GLP-1 receptor agonists.
• More than three cardiovascular risk factors without established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and weak against starting GLP-1 receptor agonists.
• Established CVD or CKD: Weak recommendation for starting SGLT-2 inhibitors and GLP-1 receptor agonists.
• Established CVD and CKD: Strong recommendation for starting SGLT-2 inhibitors and weak recommendation for starting GLP-1 receptor agonists.
• For those committed to further reducing their risk for CVD and CKD outcomes: Weak recommendation for starting SGLT-2 inhibitors rather than GLP-1 receptor agonists.

About SGLT-2 Inhibitors and GLP-1 Receptor Agonists

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a class of oral anti-diabetic drugs, including empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin. They increase the excretion of glucose and sodium in the urine by inhibiting SGLT-2 in the kidney, thus lowering the blood glucose level. They may also slightly lower blood pressure and body weight.

Glucagon-like peptide 1 (GLP-1) receptor agonists are a class of non-insulin injection anti-diabetic drugs, including exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, semaglutide, and loxenatide. They mimic the intestinal hormone incretin and bind its receptor, which slows the rate at which food leaves the stomach, controls the appetite, and regulates insulin and glucagon secretion.

Reference

"SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline," is published in the BMJ.

DOI: https://www.bmj.com/content/373/bmj.n1091