Combination therapy with GLP ‐1 receptor agonist and SGLT2 inhibitor
Open accessAbstract
The SGLT2 inhibitors ( SGLTi ) and glucagon‐like‐1 receptor agonists ( GLP ‐1 RAs ) effectively reduce HbA1c , but via very different mechanisms, making them an effective duet for combination therapy. Recently, drugs in both of these antidiabetic classes have been shown to reduce cardiovascular events, most probably by different mechanisms. SGLT2i appear to exert their CV protective actions by haemodynamic effects, while GLP ‐1 RAs work via anti‐atherogenic/anti‐inflammatory mechanisms, raising the possibility that combined therapy with these 2 classes may produce additive CV benefits. The SGLT2i and GLP ‐1 RAs also reduced macroalbuminuria, decreased the time for doubling of serum creatinine, and slowed the time to end‐stage renal disease. In this perspective, we review the potential benefit of combination SGLT2i / GLP ‐1 RA therapy on metabolic‐cardiovascular‐renal disease in patients with type 2 diabetes mellitus.
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Direct kidney effects of GLP1-RA include increasing natriuresis and diuresis, decreasing oxidative stress and inflammation, and possible glomerular hemodynamic effects.
“Direct effects include increasing natriuresis and diuresis, decreasing oxidative stress and inflammation, and possible glomerular hemodynamic effects.”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [32]
GLP1-RA may exert favorable effects on the kidneys through direct or indirect effects.
“GLP1-RA may exert favorable effects on the kidneys through direct or indirect effects (Fig. 1/Central Illustration) [31], [32], [33], [34].”
From Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: a review of their kidney and heart protection (2023) · cites this paper as [32]
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Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents
Di Pino, A., & DeFronzo, R. A. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00141 · Cited by 535 · see citing works
Self-citationShaman, A. M., Bain, S. C., Bakris, G. L., Buse, J. B., Idorn, T., Mahaffey, K. W., Mann, J. F. E., Nauck, M. A., Rasmussen, S., Rossing, P., et al. (2022) · Circulation · doi:10.1161/circulationaha.121.055459 · Cited by 255 · see citing works
Pioglitazone: the forgotten, cost-effective cardioprotective drug for type 2 diabetes
DeFronzo, R. A., Inzucchi, S., Abdul-Ghani, M., & Nissen, S. E. (2019) · Diabetes and Vascular Disease Research · doi:10.1177/1479164118825376 · Cited by 223 · see citing works
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Clegg, L. E., Penland, R. C., Bachina, S., Boulton, D. W., Thuresson, M., Heerspink, H. J. L., Gustavson, S., Sjöström, C. D., Ruggles, J. A., Hernandez, A. F., et al. (2019) · Cardiovascular Diabetology · doi:10.1186/s12933-019-0942-x · Cited by 94 · see citing works
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- Authors
- DeFronzo, R. A.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- DeFronzo, Ralph A.
- ORCID
- DeFronzo, Ralph A.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-06-07
- Volume
- 19
- Issue
- 10
- Pages
- 1353-1362
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC5643008
- OpenAlex
- W2607109151
- Cited by
- 192
- References
- 79
- Citations by year
- 2026: 20 · 2025: 21 · 2024: 28 · 2023: 17 · 2022: 19 · 2021: 25 · 2020: 20 · 2019: 17 · 2018: 20 · 2017: 5
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DK24092‐33)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- SGLT2 inhibitors, GLP-1 receptor agonists, combination therapy, type 2 diabetes, cardioprotection, renal protection, albuminuria, end-stage renal disease, anti-inflammatory mechanism, hemodynamic effects, glycemic control
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Drug Therapy, Combination, Humans, Hypoglycemic Agents, Kidney Failure, Chronic, Disease Progression, Sodium-Glucose Transporter 2
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