Which Therapies Are Best for You? Breaking Down SGLT-2s and GLP-1s
By Julia KenneyAshwin ChettyMatthew Garza
When it comes to SGLT-2s and GLP-1s, there are several medicines available. Read below for more information on these therapies which have particular benefits for those with heart and/or kidney disease.
There are many different brands of SGLT-2 inhibitors and GLP-1 receptor agonists that have proven to be effective in lowering glucose levels in people with type 2 diabetes. These therapies are especially helpful for people with diabetes who have kidney disease, heart disease, or heart failure.
At this year’s ADCES 2021 conference, Dr. Sam Grossman, from the New York Harbor Healthcare System, and Dr. Sara Reece, from the Philadelphia College of Osteopathic Medicine, outlined the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists.
When healthcare professionals are deciding how to prescribe these two classes of medicines, the 2021 ADA Standards of Care recommends the following:
-
For people with diabetes without established heart disease, kidney disease, or heart failure – Prioritize minimizing hypoglycemia, weight loss, and low cost
-
For people with heart disease and type 2 diabetes – Use a GLP-1 or SGLT-2 that has proven heart benefits.
-
For people with heart failure and type 2 diabetes (primarily heart failure with reduced ejection fraction) – Use an SGLT-2 with proven heart failure benefits
-
For people with kidney disease and type 2 diabetes -– Use an SGLT-2 that has proven kidney benefits. If that is not available, then a GLP-1 or SGLT-2 with proven heart benefits.
Overall, Dr. Grossman and Dr. Reece recommend both of these medication classes if you have, or are at high risk for, heart disease. They also recommend SGLT-2 inhibitors specifically if you have, or are at high risk for, heart failure or kidney disease. The table below summarizes these recommendations, though these are not strict guidelines, especially given the difficulty in comparing drugs within the same class to one another. It’s important to talk to your doctor about your options.
Below are the various GLP-1receptor agonists and SGLT-2 inhibitors:
GLP-1 Receptor Agonist Treatment Recommendations
|
Complication |
Treatment |
Impact |
|
Heart Disease |
Ozempic (Novo Nordisk) |
In clinical trials these therapies improved heart health and glucose control. |
|
Victoza (Novo Nordisk) |
||
|
Trulicity (Eli Lilly) |
||
|
Rybelsus (Novo Nordisk) |
In clinical trials these therapies improved glucose control and did not impact heart health in a positive or negative way. |
|
|
Adlyxin (Sanofi) |
||
|
Bydureon (AstraZeneca) |
SGLT-2 Inhibitor Treatment Recommendations
|
Complication |
Treatment |
Impact |
|
Heart Disease |
Farxiga (AstraZeneca)
|
In clinical trials this therapy improved glucose control and reduced the risk of heart-related death. |
|
Jardiance (Lilly/BI) |
In clinical trials these therapies improved glucose control and reduced the risk for heart disease, stroke, or heart-related death. |
|
|
Invokana (J&J) |
||
|
Steglatro (Merck Pfizer) |
In clinical trials this therapy improved glucose control and did not impact heart health in a positive or negative way. |
|
|
Heart Failure
|
Farxiga (AstraZeneca) |
In clinical trials all three therapies reduced hospitalizations for heart failure. |
|
Invokana (J&J) |
||
|
Jardiance (Lilly/BI) |
||
|
Kidney Disease |
Farxiga (AstraZeneca) |
In clinical trials all three therapies reduced kidney disease progression.
|
|
Invokana (J&J) |
||
|
Jardiance (Lilly/BI) |
Dr. Reece and Dr. Grossman also summarized some of the disadvantages of using GLP-1s and SGLT-2s.
GLP-1 Receptor Agonists
-
Side effects may include nausea, vomiting, diarrhea, and injection site reactions.
-
People with a history of thyroid C-cell tumors should not take GLP-1s.
-
There is an increased risk of hypoglycemia when taking GLP-1s with a sulfonylurea or insulin.
-
GLP-1s are more expensive than some other glucose-lowering medications, like sulfonylureas (SFUs), metformin, and TZDs.
SGLT-2 Inhibitors
-
There is an increased risk of frequent urination, dehydration, and hypotension, especially if you are on a diuretic medication.
-
The most common side effect for SGLT-2s is genital mycotic infection.
-
SGLT-2s are a newer therapy and can be more expensive than other type 2 diabetes drugs, such as sulfonylureas, metformin, and TZDs.
-
Using SGLT-2s in type 1 diabetes increases the risk of – and decreases the ability to diagnose – diabetic ketoacidosis (DKA), a dangerous complication that can become life-threatening if untreated.
For those considering a GLP-1 or SGLT-2, consult your healthcare providers to learn more about your most effective treatment plan and what options may be the most cost-effective for you.
To learn more, check out some of our other resources on this subject:
