A wide-scale study has identified how using two types of diabetes drugs together offers extra protection against heart and kidney disease in people with diabetes.
One type of drug, SGLT2is or gliflozins, reduces blood glucose by increasing how much is excreted in the urine.
Another drug, GLP-1RAs such as Ozempic, boost insulin release and sensitivity.
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Impaired glucose control that occurs with diabetes can cause damage to blood vessels in the heart and kidneys, putting those with the condition at risk of cardiovascular and kidney disease.
While both SGLT2is and GLP-1RAs are known to improve cardiovascular outcomes, less is known about how combining these two drugs can protect against heart disease and kidney failure.
Previous studies, which have been smaller and short-term, have shown that this combination can support blood glucose control.
Researchers combined data from 12 large studies of SGLT2is, covering 73,238 patients with diabetes.
Of these, 3,065 were also receiving GLP1-RAs. They found the protective benefits of SGLT2is were seen independently of GLP1-RA treatment.
A key finding was that SGLT2is lowered the risk of severe cardiovascular events, including stroke and death, by 11%, while the risk of cardiovascular death or being admitted to hospital for heart failure was reduced by 23% against placebo, even when used alongside GLP1-RAs.
The research team also found that SGLT2is, when added to GLP1-RAs, reduced the risk of chronic kidney disease progressing by 33%, while the annual loss of kidney function was slowed by around 60%.
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Combining the two drugs did not result in any new safety issues, researchers said.
Lead author Clinical Associate Professor Brendon Neuen, from the Royal North Shore Hospital in Sydney, said: “Given the rapidly expanding indications for the use of GLP-1 receptor agonists, it was important to look at their effects with SGLT2 inhibitors.
This study represents the largest and most comprehensive assessment of clinical outcomes for this combination of medicines.
“SGLT2 inhibitors have clear protective effects against heart failure and chronic kidney disease, while GLP-1 receptor agonists can reduce the risk of heart attack, stroke, and also kidney disease.
“Our findings support using this combination to further improve outcomes in patients with type 2 diabetes who meet guideline recommendations for both therapies.”
Read more in The Lancet Diabetes & Endocrinology.
