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

Abstract

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.