Pairing an SGLT2 drug with a GLP-1 mostly matched either one alone

Combining two diabetes drug classes did not beat either one used alone on heart and kidney outcomes, according to a pooled analysis of 12 randomized trials covering 99,683 people with type 2 diabetes. Risk ratios came in at 0.86 and 0.95 for heart outcomes and 1.05 and 0.86 for kidney outcomes, close enough to even that the researchers read them as a wash.

Doctors have been prescribing the two together on the reasonable theory that two different organ-protecting mechanisms stack. Pooled, that stacking mostly does not appear, with one exception: a lower risk of hospital admission for heart failure, at a risk ratio of 0.72 against an SGLT2 drug alone and 0.62 against a GLP-1 alone.

Every one of those comparisons carries a very low certainty grade, the weakest the authors could assign. Much of the evidence leans on subgroup data drawn from trials designed to answer other questions, and on the heart failure result the confidence interval runs to 0.99, a hair away from even.

What is still unknown is whether a trial built for this exact question would land in the same place, which is what the authors have asked for. Any decision about running these two together belongs with a qualified clinician who knows a person's health history.

Read the full story at Medscape ↗

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