GLP-1 Agonists and SGLT-2 Inhibitors for Patients With Diabetes
Glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are often prescribed to patients with type 2 diabetes to address a range of aspects related to their diabetes management, including glucose control, and weight loss. These medications are also utilized to decrease the risk of heart failure and kidney disease, among other cardiovascular and renal complications, in this patient population.
To learn more about how GLP-1 agonists and SGLT-2 inhibitors may provide cardiometabolic and renal protection for these patients, Consultant360 reached out to Sara Reece, PharmD, CDECES, who is the director of interpersonal education and vice chair and associate professor in the School of Pharmacy at the Philadelphia College of Osteopathic Medicine in Moultrie, Georgia. Dr Reece recently presented on this topic at the Association of Diabetes Care & Education Specialists (ADCES) 2021 Conference.
Consultant360: To begin, could you give us a brief overview of your session?
Sara Reece: The session provided an overview of data from landmark clinical trials and guidelines addressing glycemic and cardiovascular outcomes in the role of GLP-1 agonists and SGLT-2 inhibitors in the treatment of type 2 diabetes. Additionally, the session allowed participants to develop a treatment plan addressing cardiovascular, renal, and glycemic needs for given case scenarios while also integrating the role of diabetes care and education specialists in developing a diabetes medication regimen.
C360: Could you briefly discuss the latest clinical guideline updates involving GLP-1 agonists and SGLT-2 inhibitors? How does the latest update of the guidelines differ from previous guidelines?
SR: The American Diabetes Association Standards of Medical Care in Diabetes 2021 recommends considering indicators of high risk, defined as aged 55 years or older with artery stenosis (coronary, carotid, or lower-extremity) of more than 50% or left ventricular hypertrophy, or established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or heart failure when determining treatment for type 2 diabetes.
The 2021 standards differ from previous guidelines in the recommended use of GLP-1 agonists and/or SGLT-2 inhibitors independently of baselines A1c, individualized A1c target or metformin use for persons with type 2 diabetes who have high risk or established ASCVD, CKD, or heart failure. For persons with type 2 diabetes, heart failure with reduced ejection fraction (HFrEF), or CKD (diabetes-related kidney disease and albuminuria), SGLT-2 inhibitors with proven benefit are recommended. For persons with established ASCVD or indicators of high risk, GLP-1 agonists (liraglutide, semaglutide, dulaglutide) and SGLT-2 inhibitors (canagliflozin, empagliflozin) with proven cardiovascular disease benefit are recommended.
C360: Could you briefly discuss why it is important to have a multidisciplinary team approach to treating diabetes using GLP-1 agonists and SGLT-2 inhibitors?
SR: Diabetes is a chronic condition on the cardiometabolic spectrum encompassing cardiovascular, metabolic, and renal aspects. Thus, treatment of diabetes must address cardiovascular, metabolic, and renal needs, and a multidisciplinary team approach, including primary care physicians, cardiologists, nephrologists, nurses, pharmacists, and diabetes care and education specialists, is required to address all these needs.
C360: What are the key takeaways from your session?
SR: Some of the key takeaways from this session include that a comprehensive approach to address both cardiometabolic and renal diseases is essential in the treatment of type 2 diabetes. In patients who have established ASCVD and/or high risk for ASCVD, GLP-1 receptor agonists are preferred based on their cardiovascular disease risk reduction. Further, SGLT-2 inhibitors—with benefits for heart failure and delaying progression of CKD—are preferred in patients with type 2 diabetes, heart failure, and/or CKD.
Reece SW, Grossman S. GLP-1 agonists and SGLT-2 inhibitors: cardiometabolic and renal protection. Talk presented at: Association of Diabetes Care & Education Specialists Conference; August 12-15, 2021; Virtual. https://adcesmeeting.org/2021/ADCES21/agenda.asp?startdate=8/12/2021&enddate=8/12/2021&BCFO=&pfp=BrowsebyDay&tn=&cpf2=&cus2=&pta=