Vol 9, No 4 (2020)
Research paper
Published online: 2020-07-27

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Clinical effectiveness of combination therapy with dulaglutide, SGLT2 inhibitor and metformin with or without insulin in Indian adults with type 2 diabetes: a real-world retrospective study

Supratik Bhattacharyya1
Clin Diabetol 2020;9(4):233-238.


Background. Antidiabetic agents such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose cotransporter-2 inhibitors (SGLT2i) are known to improve glycaemic control with favourable impact on cardiovascular (CV) risk factors. Given the potential benefits, this study evaluated the clinical effectiveness of combination therapy including dulaglutide, SGLT2i and metformin with or without insulin in Indian adults with inadequately controlled T2DM.

Material and methods. This retrospective, real-world, single-centre study included 15 adults (mean age [SD, standard deviation]: 49.47 [9.29] years) with inadequately controlled T2DM. The patients received a combination of dulaglutide, SGLT2i and metformin with or without insulin. Changes in fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycosylated haemoglobin (HbA1c), body weight, BMI, vascular age (VA), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were examined for a follow-up duration of 3 months. Self-reported adverse events were also recorded.

Results. At the 3-month follow-up, the combination therapy resulted in significant reduction (P < 0.001) in glycaemic parameters such as FBG, PPBG and HbA1c with a mean reduction (MR [SD]) of 66.67 (40.05) mg/dL, 83.33 (64.11) mg/dL and 1.78 (1.08) % respectively. A significant reduction (P < 0.001) in body weight and corresponding BMI was demonstrated with an MR (SD) of 6.40 (3.96) kg and 2.67 (1.63) kg/m2 respectively. Similarly, significant reductions (P < 0.05) were also recorded for SBP (4.40 [4.61] mm Hg) and DBP (2.80 [3.84] mm Hg). The therapy was also associated with significant reduction (P < 0.001) in VA (MR [SD]: 3.93 [2.46] years). The therapy was well tolerated; however, self-reported gastrointestinal symptoms were reported in 5 patients, which subsided within 2 weeks of therapy initiation.

Conclusion. Combination therapy with dulaglutide, SGLT2i and metformin with or without insulin resulted in significant improvements in glycaemic parameters, body weight and SBP in Indian adults with inadequately controlled T2DM. Interestingly, there was a significant improvement in vascular age associated with the therapy.

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  1. Busch RS, Kane MP. Combination SGLT2 inhibitor and GLP-1 receptor agonist therapy: a complementary approach to the treatment of type 2 diabetes. Postgrad Med. 2017; 129(7): 686–697.
  2. Kennedy M, Roberts A. Complex type 2 diabetes mellitus--management challenges and pitfalls. Aust Fam Physician. 2013; 42(4): 207–210.
  3. Zegarac JP. SGLT2 Inhibitor, GLP-1 receptor agonist combination treatment for type 2 diabetes: Expert insights. www endocrinologyadvisor com. https://www.endocrinologyadvisor.com/type-2-diabetes-advisor/combination-sglt2-glucagon-like-peptide-1-receptor-agonist-t2d/article/769123/. Accessed January 9, 2019.
  4. van Baar MJB, van Ruiten CC, Muskiet MHA, et al. SGLT2 inhibitors in combination therapy: from mechanisms to clinical considerations in type 2 diabetes management. Diabetes Care. 2018; 41(8): 1543–1556.
  5. Gerstein HC, Colhoun HM, Dagenais GR, et al. REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019; 394(10193): 121–130.
  6. Mody R, Grabner M, Yu M, et al. Real-world effectiveness, adherence and persistence among patients with type 2 diabetes mellitus initiating dulaglutide treatment. Curr Med Res Opin. 2018; 34(6): 995–1003.
  7. Ghosal S, Sinha B. Liraglutide and Dulaglutide therapy in addition to SGLT-2 inhibitor and metformin treatment in Indian type 2 diabetics: a real world retrospective observational study. Clin Diabetes Endocrinol. 2018; 4: 11.
  8. Goncalves E, Bell DSH. Combination treatment of SGLT2 inhibitors and GLP-1 receptor agonists: symbiotic effects on metabolism and cardiorenal risk. Diabetes Ther. 2018; 9(3): 919–926.
  9. Ludvik B, Frías JP, Tinahones FJ, et al. Dulaglutide as add-on therapy to SGLT2 inhibitors in patients with inadequately controlled type 2 diabetes (AWARD-10): a 24-week, randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2018; 6(5): 370–381.
  10. Curtis L, Humayun M, Walker J, et al. Addition of SGLT2 inhibitor to GLP-1 agonist therapy in people with type 2 diabetes and suboptimal glycaemic control. Practical Diabetes. 2016; 33(4): 129–132.
  11. Dakik HA. Vascular age for predicting cardiovascular risk: A novel clinical marker or just a mathematical permutation. J Nucl Cardiol. 2019; 26(4): 1356–1357.
  12. Łoboz-Rudnicka M, Jaroch J, Kruszyńska E, et al. Relationship between vascular age and classic cardiovascular risk factors and arterial stiffness. Cardiol J. 2013; 20(4): 394–401.