Jennifer Green, MD: Outcomes, Impact of SGLT2i, GLP-1 RA Combination Therapy


Dr. Green discusses the potential of combination therapy to reduce cardiovascular and kidney outcomes in people with type 2 diabetes.

There has been notable interest in using a combination of sodium-glucose co-transporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) to reduce the risk of cardiovascular and kidney outcomes in individuals with type 2 diabetes (T2D).

In an interview with HCPLive, Jennifer Green, MD, Duke University School of Medicine, provided insight into her presentation on the summary of data on each drug class given to patients with T2D.

Green noted that the combination of SGLT2 and GLP-1 RA leads to greater lowering in glucose and potentially weight loss compared to each, which she considers a good starting place.

However, she noted there is dedicated analyses and cardiovascular outcome trials where investigators look at GLP-1 RA in combination with or without SGLT2i benefited equally from the GLP-1 RA.

"The data that we have so far suggests that if you're already on an SGLT2i which should provide its own risk reduction, and you were further treated with a GLP-1 RA, that you benefit just as much as someone who's not on an SGLT2i, so it requires a, shall we say, a leap of faith, or you need to understand that they're already on a beneficial drug," Green said. "And then if you add the next, it does appear to provide a further benefit."

Due to available, powerful agents to lower CV risk and T2D, Green noted that randomized trials may have a difficult time determining a difference in outcomes with confidence.

"At the present time, there there are trials like that under discussion and and attempts to perform those trials embedded into usual clinical care," Green said. "But I'm not sure that they've gotten terribly far yet, we certainly don't have any results."

Moreover, Green pointed out that although combination therapy is worthwhile to think about, clinicians need to prioritize high risk patients with one medicine class to reduce CV risk.

"We need to make sure that the highest risk patients are being are being treated appropriately and that's really the most effective way to alter population health," Green said. "So let's start there and then we can think about combination therapy after that."

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