Two types of diabetes drugs similarly effective in reducing heart and kidney disease
Two newer types of medications commonly used to treat type 2 diabetes are similar in their ability to reduce major heart complications, including heart attack, stroke and death from cardiovascular disease, according to research accepted for presentation at ENDO 2020, the Endocrine Society’s annual meeting, and publication in a special supplemental section of the Journal of the Endocrine Society.
One class of drugs, known as SGLT2 inhibitors, has a clear benefit over the other class, known as GLP-1 drugs, in reducing hospitalization for heart failure, the study found. “This helps doctors more easily choose a medicine to best treat diabetes,” said lead study author Ali Al-Khazaali, M.D., of Saint Louis University in St. Louis, Mo.
SUN-618: Decision Analysis for Glucagon-Like Peptide Receptor Agonists vs. Sodium-Glucose Cotransporter 2 Inhibitors in Type 2 Diabetes Mellitus
Background: Cardiovascular outcome trials (CVOT) of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i ) demonstrated reduction of major adverse cardiovascular events (MACE), cardiovascular deaths (CVD), and renal outcomes (RO). Objective. Evaluation of data to assist in the prescribing decision with regard to severity of illness and risk for adverse events.
Study Design: Systemic review of the major CVOT and previous meta-analyses.
Main Outcome Measures: Analysis of six trials on GLP-1 RA and 4 trials on SGLT2i, showed both drug classes reduced MACE and CVD compared to controls, with neither class preferred (comparison GLP1-RA vs SGLT2i: (relative rate, rr MACE= 1.09, 95%CI;0.98,1.22, p= 0.129; rr, CVD =1.04, CI;0.87,1.24, p=0.657). Hospitalization for heart failure (HHF) improved with SGLT2i (rr=0.68, CI; 0.61,0.76, p<0.001) but not with GLP-1 RA, (rr = 0.94, CI; 0.86,1.03, p=0.17). Both GLP-1 RA and SGLT2i showed significant reduction in RO (GLP-1RA, rr=0.83, CI; 0.75,0.912, p=<0.001, SGLT2i, rr=0.0.67, CI; 0.57,0.79, p=0.001) without a preferential difference between the classes ( GLP-1 RA vs SGLT2i, relative difference (rd) =0.005, CI;- 0.011,0.021, p=0.532, number needed to treat (NNT)=200). Serious adverse events (SAE) for SGLT2i were predominantly mycotic genital infections in women (number needed to harm (NNH) =13 and diabetic ketoacidosis NNH=595. Gastrointestinal intolerance was the major SAE in the GLP1-RA class (NNH=35).
Conclusion: Both GLP-1 RA and SGLT2i classes showed similar reduction in MACE, CVD, and RO. SGLT2i have advantages over GLP-1 RA in reduction in HHF especially in those with more severe cardiovascular disease risk.
