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Less Insulin for Patients With Type 2 That Add On An SGLT2 Inhibitor

Aug 11, 2018
 

Adding an SGLT2 inhibitor to insulin therapy for patients with type 2 diabetes who’d required large doses of insulin helped them reduce their insulin dose.

Hypoglycemia and weight gain are a common side effect of insulin therapy, but what if we use it as dual therapy in combination with SGLT2 inhibitors? Do those side effects remain the same or there is an improvement in the quality of life of patients who have diabetes mellitus (T2DM)?

Delays in the optimization of glycemic control therapy can result in cardiovascular events, renal problems, blindness, and other conditions. he addition of SGLT2 inhibitors to the insulin therapy in patients with T2DM can reduce common side effects of insulin therapy.

The authors of “When Insulin Therapy Fails: The Impact of SGLT2 Inhibitors in Patients With Type 2 Diabetes” used data from WebDR to evaluate the Real World clinical impact of SGLT2 inhibitors as an add-on to insulin therapy in patients with type 2 diabetes who do not achieve the glycemic goals. The data used was of canagliflozin and dapagliflozin during a 35-month period.

The study included 411 patients and the mean age of 57 years old. Other inclusion criteria included: diagnosed type 2 diabetes for at least 15 years, HbA1c of 9%, BMI of 36.3 kg/m2, and median baseline insulin dose of 75 insulin units per day. 71.8% of the study population had one or more complications related with the diabetes. These characteristics are unique in the Real World research since this kind of population is typically excluded from RCTs. They performed a multiple regression analysis with age, sex, and duration of the disease in a year’s adjustments. a significant reduction of HbA1c, blood pressure, weight loss, and decreased amount of insulin necessary to reach glycemic control was observed. These characteristics were observed in both drugs, canagliflozin, and dapagliflozin.

The authors focused on the considerable reduction in insulin dose between patients using 100 units/day or more. Patients with daily insulin doses between 101 and 200 units/day experienced an insulin dose reduction of 17 units/day with the addition of canagliflozin to their therapy. The reduction of insulin dose in those patients on 200 or more insulin units/day was observed between 21 and 23 units/day. When dapagliflozin was used on the same population, the insulin dose reduction was between 71 and 77 units, both measured at 3 and 6 months.  Hypoglycemia is an observed adverse effect in the combination therapy of SGLT2 inhibitors and insulin, the authors failed to provide data regarding this events.

A unique attribute the authors stated is that this is the first research in the United States that has been focused on the Real World impacts in the combination of SGLT2 inhibitors and insulin in patients with T2DM. The optimization of glycemic therapy is a topic in which more real-world studies have to be done in order to take full advantage of the insulin combination therapies.

Practice Pearls:

  • Despite the addition of SGLT2 Inhibitors and the decrease in daily insulin doses, some patients can still experience inadequate glycemic management.
  • The addition of canagliflozin or dapagliflozin to the insulin regimen leads to decrease in the insulin doses in those patients who have T2DM using high doses of insulin.
  • The Real World impact of SGLT2 inhibitors in patients with T2DM should be the topic of future research to help improve the quality of life of this specific population.

Harris SB, Mequanint S, Miller K, Reichert SM, Spaic T. When Insulin Therapy Fails: The Impact of SGLT2 Inhibitors in Patients With Type 2 Diabetes. Diabetes Care. http://care.diabetesjournals.org/content/40/10/e141. Published October 1, 2017.

Kennen Munoz Munoz, Pharm. D. Candidate 2019, LECOM School of Pharmacy