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SGLT2 inhibitors ‘display advantage’ in HbA1c outcomes

By Editor
13th March 2018

SGLT2 inhibitors “may display advantage” compared to other oral agents in achieving HbA1c targets, a study has suggested.

The research, published in Diabetes, Obesity and Metabolism, aimed to determine, using published general practice-level data, how differences in prescribing patterns for type 2 diabetes relate to glycaemic target achievement levels.

The researchers, mainly from the University of Manchester, set out on the investigation because the paper stated: “despite increasing spend on new Type 2 diabetes mellitus (T2DM) therapies, the proportion of people with T2DM achieving target glycaemia outcomes is declining”.

SGLT2 inhibitor is a class of drug which helps to lower blood glucose levels by reducing the amount of glucose absorbed in the kidneys so that it is passed out in the urine.

Multiple linear regression modelling was used to link practice characteristics and defined daily dose of class of medication in 2015/16 and changes to 2014/15 in medication to proportions achieving target glycaemic control.

The results showed: “Overall, HbA1c outcomes were not different between the years studied. Although in percentage terms most practices increased their use of Sodium–glucose co-transporter 2 inhibitors (SGLT-2Is) (96 per cent), Dipeptidyl peptidase-4 inhibitors (DPP-4Is) (76 per cent) and glucagon-like peptide 1 (GLP-1) analogues (53 per cent), there was wide variation in use of older and newer therapies.

“For example, 12 per cent of practices use >200 per cent national average of some newer agents. In cross-sectional analysis: greater prescribing of metformin and analogue insulin were associated with a higher proportion achieving HbA1c <58 mmol/mol; SGLT-2Is and metformin were associated with reduced proportion of HbA1c >86 mol/mol; otherwise associations for sulphonylureas, GLP-1 analogues, SGLT-2Is and DPP-4Is were neutral or negative.

“In year-on-year analysis there was ongoing deterioration in glycaemic control which was offset to some extent by increased use of SGLT-2Is and GLP-1 analogues, which were associated with a greater proportion achieving HbA1c <58 mmol/mol and a less proportion of people at >86mmol/mol. SGLT-2I prescribing was associated with significantly greater improvements than those found for GLP-1 analogues.”

The researchers concluded: “Increased use of newer agents was associated with improvement of glycaemic outcomes but not sufficient to compensate for prevailing decline. This may reflect wide variability in the prescribing of newer agents. We have found that SGLTIs may display advantage vs other oral agents in relation to HbA1c outcome. Serious consideration should be given to their use.”

To access the study, click here.

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