Clinical Efficacy Evaluation and Longterm Prognosis of Glucagonlike Peptide1 Combined With Sodium Glucose Cotransporters
Clinical Efficacy Evaluation and Longterm Prognosis of Glucagonlike Peptide1 Combined With Sodium Glucose Cotransporters
Clinical Efficacy Evaluation and Longterm Prognosis of Glucagonlike Peptide1 Combined With Sodium Glucose Cotransporters
Pi et al.: Evaluation of Glucagon-Like Peptide-1 Combined with Sodium Glucose Cotransporter-2 Inhibitor in Diabetes
To investigate the clinical worth of glucagon-like peptide-1 receptor agonist (liraglutide) combined with
sodium glucose cotransporter-2 inhibitor (dapagliflozin) in the treatment of overweight or obesity patients
with type 2 diabetes mellitus and to explore whether the beneficial effect of the combination can persist
during a 1 y follow-up. Eighty overweight or obesity type 2 diabetes mellitus patients admitted to a hospital
from January 2019 to January 2020 were randomly divided into a control group and an observation group,
with 40 cases in each group. The control group was treated with liraglutide and the experimental group
was treated with basic dapagliflozin in the control group. All patients were continuously treated for 12 w.
The measurement results of parameters before and after treatment, the changes in glucose metabolism
parameters, blood lipid metabolism parameters and the occurrence of adverse reactions during treatment
were recorded. After that, 74 treated patients were followed up for 1 y (6 refused) and measurements of
various parameters were recorded. The differences in body mass index, waist circumference, hemoglobin
A1c, fasting plasma glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-
density lipoprotein cholesterol, homeostatic model assessment-insulin resistance, homeostatic model
assessment-beta and insulin sensitivity index before and after treatment in the experimental group were
higher than those in the control group (p<0.05). Weight loss during treatment was sustained over 1 y in
both groups, with more significant changes in the experimental group. The combination of glucagon-like
peptide-1 agonist and sodium glucose cotransporter-2 inhibitor can improve diabetes in overweight or
obesity patients with type 2 diabetes mellitus and effectively reduce blood glucose and body mass index,
which is of great significance for reducing body weight and improving efficacy. Therefore, using glucagon-
like peptide-1 agonists and sodium glucose cotransporter-2 inhibitors in overweight, diabetic patients is a
promising option.
Key words: Diabetes mellitus, glucagon-like peptide-1 agonists, sodium glucose cotransporter-2 inhibitors,
liraglutide, dapagliflozin
The term "obesity" has been cast-off to define the is characterized by ongoing hyperglycemia. Visceral
pathophysiological connection between Type 2 Diabetes adipose tissue, liver, skeletal muscle and excess cardiac
Mellitus (T2DM) and obesity/overweight, most often tissue fat storage are characteristics of type 2 diabetes[6].
since the middle of the 20th century[1]. Type 2 diabetes Persistent hyperglycemia in the T2DM affected role
prevalence has rapidly grown during the last several leads to chronic damage to tissues and organs such as the
decades as obesity increases, with an estimated 422 retina, heart and kidney, as well as glucose metabolism
million individuals afflicted globally lately[2]. In many abnormalities, which pose a major danger to the patient's
situations, bariatric surgery may considerably decrease life and health[7]. Due to its anabolic effects, insulin
weight and diabetes despite just recently being a viable
choice for treating obesity[3-5]. However, many patients This is an open access article distributed under the terms of the Creative
are unwilling to undergo invasive procedures or pay Commons Attribution-NonCommercial-ShareAlike 3.0 License, which
allows others to remix, tweak, and build upon the work non-commercially,
relatively high prices. Additionally, there might be both as long as the author is credited and the new creations are licensed under
short-term and long-term negative belongings from the identical terms
bariatric surgery. A metabolic disorder called T2DM Accepted 04 August 2022
Revised 16 October 2021
Received 29 March 2021
*Address for correspondence
Indian J Pharm Sci 2022;84(4):812-820
E-mail: ppl0629@163.com
812 Indian Journal of Pharmaceutical Sciences July-August 2022
www.ijpsonline.com
treatment often causes weight gain, raising insulin MATERIALS AND METHODS
resistance[8,9].
General information:
Consequently, dialectologists treat overweight
T2DM patients with very little time spent on these Eighty overweight T2DM affected one, which was
medications. Strengthening body weight management initially pickled within a hospital from January 2019
while reducing blood glucose should be a priority for to January 2020 selected and altogether patients met
treating overweight and obese T2DM patients[10]. This the diagnostic criteria for T2DM. They remained
calls for creating novel type 2 diabetes treatments that haphazardly separated as control group and then the
don’t cause weight gain. Doctors often combine several observation group, with 40 cases in each group. In the
additional antidiuretic medications to treat diabetes control group, there remained 21 men and 19 women; the
when metformin alone is unsuccessful. Because they mean age was (52.12±10.2) y, and the mean Body Mass
are linked to weight reduction, Glucagon-Like Peptide-1 Index (BMI) was (27.31±5.7) kg/m2. In the observation
(GLP-1) agonists and Sodium Glucose Cotransporter-2 group, there were 23 men and 17 women; the mean age
(SGLT-2) inhibitors are chosen medications. SGLT-2 and was (51.23±10.4) y, and the mean BMI was (27.82±5.6)
GLP-1 analog medically favorable preliminary findings kg/m2.
have been seen in diabetic combination treatment with
Exclusion criteria: Pregnant or lactating women;
inhibitors[11,12]. In these investigations, more individuals
complicated with severe heart, lung, liver and kidney
receiving combination treatment showed improvement
dysfunction and diagnosed with severe osteoporosis
in their modest weight loss and glycosylated hemoglobin
and provocative fracture. The education was accepted
levels (Hemoglobin A1c (HbA1c)). Liraglutide is a GLP-
through the clinic morals board, and affected role
1 Receptor Agonist (GLP-1RA) that is often prescribed
besides their relatives and informed agreement form.
to persons through sort 2 diabetes for glycemic
The difference in overall statistics among the 2 groups
management. Liraglutide consumes several actions,
obligated no statistical significance (p>0.05) with
enhancing repletion and stimulating glucose-dependent
comparability.
insulin release from beta-cells, lowering calorie intake
and promoting weight reduction. Study methods:
Liraglutide primarily targets subcutaneous fat; visceral Following admission, all patients received advice from a
fat is not affected[13,14]. As an alternative, liraglutide dietitian about their diabetic diets, medical professionals
causes a dose-dependent, fast weight loss lasting up monitored their blood pressure and fingertip blood
to 2 y[15,16]. While decreasing food consumption may glucose levels and different parameter values were
account for some of the causes of weight reduction, yes accurately measured and documented. Improve the
GLP-1 analogues have been found to impact energy detection of negative patient responses, therapy and
metabolism[17]. In animal studies, GLP-1 analogues workout advice. Liraglutide was injected subcutaneously
enhanced the heat production in Brown Adipose Tissue into the abdomen of the control group once daily, just
(BAT) and brown adipocyte degeneration, indicating before breakfast. After a week of therapy, the dosage
that GLP-1 analogues may at least partially contribute to was proportionally raised to 1.8 mg/d from the original
weight reduction via activating BAT[18]. In contrast, some 0.6 mg/d. On the same schedule as the control group,
investigations[19, 20] have not been able to show an increase dapagliflozin was given orally to the experimental group
in energy expenditure after GLP-1 analogue therapy. once a day, just before breakfast, at a dosage of 10 mg/
Innovative therapy for diabetes with insulin resistance time. All patients received continuous care in the hospital
is dapagliflozin. It accomplishes the goal of reducing for 12 w, after which they had a year of follow-up.
blood glucose and provides weight reduction and blood
pressure regulation benefits by blocking SGLT2 in renal Outcome measures:
tubular epithelium. Here, we present the findings of a
All patients had their body weight and waist
study on patients who were administered a GLP-1 agonist
circumference measured before and after treatment, and
in conjunction with SGLT-2 inhibitors. 1 y of follow-
their BMI was calculated. Additionally, their Triglyceride
up research, further exploration of the combination use
(TG), Total Cholesterol (TC), High-Density Lipoprotein
of SGLT-2 inhibitors and GLP-1 agonists treatment of
Cholesterol (HDL-C), and Low-Density Lipoprotein
together temporary besides permanent consequences.
Cholesterol (LDL-C) levels, Fasting Plasma Glucose
Out of the 80 patients, 74 were followed up for a year will make the loss in pancreatic-cell function worse[22].
and 6 declined to take part; 4 in the control group and 2 Consequently, while treating T2DM caused by obesity
in the experimental group. Survey findings revealed that and excess weight, when choosing a course of therapy
the patient’s metabolic parameters had greatly improved, for patients, numerous factors should be taken into
with an average weight loss of 3.27 kg, a reduction in account in addition to efficiently lowering blood sugar.
glycosylated hemoglobin of 2.88 % and a reduction in In order to successfully decrease the pace of gastric
BMI of 2.33 kg/m2. The mixture considerably decreased emptying and raise the patient’s satiety, liraglutide may
the need for insulin (mean 6.8 units). Although Estimated increase the number of cells in the arcuate nucleus of
Glomerular Filtration Rate (EGFR) fell by 2.88 ml/min the hypothalamus Cocaine and Amphetamine-Regulated
and mean creatinine rose by 1.67 mol/l, there was a Transcript (CART), messenger Ribonucleic Acid
general decline in renal function that was not statistically (mRNA) levels. This creates a positive feedback loop
noteworthy. Baseline HbA1c was as an independent in the body that lowers the patient’s BMI[23]. Contrarily,
predictor of decreased glycated hemoglobin, according dapagliflozin is a very selective SGLT2 inhibitor, and its
to multivariate analysis using linear regression as shown hypoglycemic action is rarely reliant on the activity of
in Table 4. islet cells, which may decrease SGLT2 expression in the
tubular epithelium. This reduces the reabsorption of urine
The study’s GLP-1 agonist SGLT-2 inhibitor
glucose[24]. Dapagliflozin may efficiently remove glucose
combination treatment protocol was administered to
from patient’s blood, lower patient’s sugar consumption
overweight patients with T2DM. T2DM and obesity
and restrict patient’s calorie intake, all of which are
it is connected, causes insulin resistance and results in
helpful for weight reduction and treating obesity.
T2DM. Seizure risk factors[21] being overweight and
Dapagliflozin T2DM combined with liraglutide efficient
obesity when using insulin and some hypoglycemic
cardiovascular disease prevention and maintenance
medications, T2DM increased insulin resistance, weight
treatment of overweight and obesity individuals was
gain and hypoglycemia are common in patients. A
made possible by effective glycemic control with
vicious loop between weight increase and dyslipidemia
considerable insulin dosage reduction BMI[25].
TABLE 2: DIFFERENCES IN MONITORING INDICATORS BEFORE AND AFTER TREATMENT BETWEEN
THE TWO GROUPS
Hypoglycemia 6 8
Dizziness 2 1
Infection 2 3
Diabetic ketoacidosis 1 1
In our study, combination treatment resulted in reasons, but the most crucial is that the patient’s blood
statistically noteworthy decreases in HbA1C, body mass glucose is under good control, followed by a decrease in
and BMI. Affected role in the experimental group fared the buildup of liver fat in the patient[29]. Alternately, it has
better than individuals in the control group; i.e., however, been discovered that SGLT receptor inhibition is linked
the combination had no statistically noteworthy impact to the synthesis of adiponectin and that dapagliflozin’s
on blood pressure management. Higher baseline HbA1c hypoglycemia mechanism may impact processes related
levels were exposed to stand a statistically noteworthy to fat metabolism[30]. Patients with T2DM who are
sovereign analyst of the grade of HbA1c decrease within overweight or obesity have persistent hyperglycemia and
additional treatments for T2DM in earlier studies[26, hyperlipidemia, which may harm pancreatic beta-cells,
27]
. Rosen stock and others had a new randomized, raise insulin resistance and lower the effectiveness of
double-blind experiment, which shows that when the conventional hypoglycemic medications.
SGLT-2 inhibitor dapagliflozin was combined with
Hyperlipidemic conditions put extra strain on the
other antidiuretic medications, higher baseline levels of
liver, which is harmful to controlling lipid and glucose
HbA1c predicted bigger decreases in HbA1c levels[28]. In
metabolism[31]. Therefore, patients must quickly restore
our subsequent poll, the high difference in mean HbA1c
islet function during the first stages of therapy and
levels at baseline may be the cause of the study’s mean
properly manage their blood sugar and cholesterol levels.
drop in HbA1c, which was 2.88 and 1.33. This finding
is consistent with prior reports on the present difference The findings of this research demonstrated that, before
effect of combination therapy. This research also showed and after therapy, the islet function indicators of patients
that the experimental group’s alterations in blood lipid in the observation group were greater than those in the
metabolism levels were noticeably improved than control group. The findings demonstrated that liraglutide
persons in the control group. Liraglutide and dapagliflozin combined with dapagliflozin effectively controlled blood
medication may alter blood lipid levels for several sugar, decreased insulin resistance, improved insulin