Is it safe to use GLP1 agonists, SGLT2 inhibitors in patients on multiple insulin injections?

Patients using multiple insulin injections demonstrate no significant difference in changes to A1c, insulin requirements, or weight after a year of treatment with a sodium glucose transporter 2 (SGLT2) inhibitor or glucagon-like peptide 1 (GLP1) receptor agonist, as shown in a study.

This retrospective, single-site, cohort study determined whether use of GLP1 agonists or SGLT2 inhibitors contributed to greater A1c reduction, weight loss, and decrease in insulin requirements among veterans with multiple daily doses of insulin.

Overall, 150 patients with type 2 diabetes of the VA Eastern Kansan Health Care system met the eligibility criteria. The authors used the SAS Enterprise Guide to complete a multivariate analysis of variance and assess all outcomes.

On average, the GLP1 group displayed a 0.65-percent decrease in A1c compared with a 1.05-percent reduction in the SGLT2 group (p=0.1397). The Basal insulin dose decreased by 5.5 units with GLP1 agonists and 2.45 units with SGLT2 inhibitors (p=0.3132), and by 7.12 versus 8.14 units, respectively, for short-acting insulin (p=0.8170).

Subsequently, weight decreased by up to 4.1 kg in the GLP1 arm compared with 3.6 kg in the SGLT2 arm (p=0.6993).

“The results suggest there is not a statistically significant difference in changes to A1c, insulin requirements, or weight after 1 year of treatment with an SGLT-2 versus GLP-1 in patients using multiple daily insulin injections,” the authors said.