Real-World Evidence of the GLP-1RA/SGLT2-i Therapy versus Standard Care: A Retrospective Cohort Study.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are effective antidiabetic therapies in patients with type 2 diabetes mellitus (T2DM). However, real-world evidence regarding the combined effectiveness and safety of these agents in this population remains limited. This study aimed to evaluate the effectiveness and safety of GLP-1RA/SGLT2-i therapy (GLP-1RAs and/or SGLT2-i) in patients with T2DM, in comparison with standard treatment approaches.

Methods: This retrospective cohort study reviewed medical records of patients with T2DM attending the diabetes clinic at the University Hospital of Sharjah. Patients on anti-diabetic medications for at least 6 months were included, while those with irregular follow-up, a T2DM diagnosis within the past year, or non-diabetic obesity were excluded. Data were collected at baseline, 3, 6, 12, and 18 months and compared the effectiveness (HbA1c, blood pressure, weight) and safety (gastrointestinal and genitourinary symptoms) of GLP-1RA/SGLT2-i therapy (GLP-1 RA and/or SGLT2-I) with standard treatment.

Results: A total of 199 patients were included in the analysis, of whom 50% were female, with a median age of 61 years (interquartile range [IQR] = 19). Patients receiving the GLP-1RA/SGLT2-i therapy demonstrated a statistically significant reduction in body weight (p = 0.002), whereas no significant weight change was observed in the standard treatment group over the 18-month follow-up period.Glycaemic outcomes showed greater improvement in the GLP-1RA/SGLT2-i therapy (median change:-2% VS -1%; p=0.001) in 18 months. Both groups demonstrated modest improvements in blood pressure, with no clear superiority observed between the treatment arms.Regarding safety, hypoglycaemia was the most commonly reported adverse event in the standard treatment group (5.5%, n=11). Within the GLP-1RA/SGLT2-i therapy group, GLP-1 RA were associated with gastrointestinal side effects in 0.5% of patients, leading to treatment discontinuation, while SGLT2 inhibitors were associated with genitourinary symptoms in 2.5% of patients.

Conclusion: GLP-1RA/SGLT2-i therapy with SGLT2-i and/or GLP-1RA showed clinically significant weight loss and HbA1c, with a low percentage of patients experiencing side effects that led to discontinuation and improvement in blood pressure.