From the Guidelines
Yes, you can use gliptin and SGLT2 inhibitors together as a combination therapy for type 2 diabetes, as it appears reasonable to use both an SGLT2 inhibitor and a GLP-1RA with demonstrated CV benefit concomitantly if clinically indicated. This is based on the 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease 1. The study suggests that the nonglycemic effects of the medication classes may be additive, with greater reductions in blood pressure and body weight in patients randomly allocated to the combination of exenatide and dapagliflozin.
Key Points to Consider
- The combination therapy of gliptin and SGLT2 inhibitors has not been studied for CVD risk reduction, but current T2D management guidelines support its use for glycemic management 1.
- The medications work through complementary mechanisms, with gliptins preventing the breakdown of incretin hormones that stimulate insulin release, and SGLT2 inhibitors reducing glucose reabsorption in the kidneys.
- Patients should be aware of potential side effects, including urinary tract infections, genital yeast infections, and upper respiratory infections.
- Regular monitoring of kidney function is important when using these medications, especially SGLT2 inhibitors.
Benefits of Combination Therapy
- Addresses multiple aspects of diabetes pathophysiology simultaneously
- Can be particularly effective for patients who do not achieve adequate blood glucose control with a single medication
- May provide greater reductions in blood pressure and body weight compared to monotherapy 1
From the Research
Combination Therapy with Gliptin and SGLT2 Inhibitors
- The combination of gliptin and SGLT2 inhibitors is a viable treatment option for type 2 diabetes, as it offers complementary mechanisms of action to control hyperglycemia 2, 3.
- Studies have shown that this combination therapy is safe and effective, with no significant increase in the risk of hypoglycemia or other adverse events 2, 3.
- The combination of dapagliflozin and saxagliptin, as well as empagliflozin and linagliptin, has been approved as a single-pill formulation, making it a convenient treatment option for patients 2, 3.
Pharmacokinetic Characteristics
- Drug-drug pharmacokinetic interaction studies have shown that the combination of gliptin and SGLT2 inhibitors does not result in significant changes in peak concentrations or total exposure of either drug 2.
- The pharmacokinetic profile of gliptins is not significantly altered by the presence of other drugs, including SGLT2 inhibitors, making it a safe combination therapy option 4.
Efficacy and Safety
- Clinical trials have demonstrated the efficacy and safety of combination therapy with gliptin and SGLT2 inhibitors, with significant improvements in glycemic control and no increased risk of hypoglycemia or other adverse events 2, 3, 5.
- The combination of dapagliflozin, sitagliptin, and metformin has been shown to be effective in achieving glycemic control in patients with type 2 diabetes poorly controlled with metformin 5.
Comparison with Other Treatment Options
- The combination of gliptin and SGLT2 inhibitors has been compared to other treatment options, including GLP-1 receptor agonists, and has been shown to be effective in improving glycemic control and reducing body weight 6.
- The triple fixed-dose combination of dapagliflozin, sitagliptin, and metformin has been shown to be significantly better than dual combination therapy in achieving glycemic control in patients with type 2 diabetes poorly controlled with metformin 5.