Role of Metformin, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Orlistat Based Multidrug Therapy in Glycemic Control, Weight Loss, and Euglycemia in Diabesity: A Real-World Experience

Overview

Journal Indian J Endocrinol Metab

Specialty Endocrinology

Date 2019 Nov 20

PMID 31741907

Citations 9

Authors

Deep Dutta

Ritu Jaisani

Deepak Khandelwal

Soumitra Ghosh

Rajiv Malhotra

Sanjay Kalra

Affiliations

Soon will be listed here.

Abstract

Background: This study evaluated the real-world weight loss and glycemic outcomes of multidrug therapy (MDT) according to various combinations of metformin, sodium-glucose cotransporter -2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor analogs (GLP1a), and orlistat in diabesity.

Methods: Data retrospectively captured from medical records of 2 different centers in New Delhi for patients >35 years-age having prediabetes/diabetes and on at least any one of the 4 above medications with >6-months follow-up was analyzed.

Results: In total, 5,336 patient records were screened; 2,442 with prediabetes/diabetes were considered; 1,509 patients who fulfilled all criteria were analyzed. Use of metformin, SGLT2i, sulfonylureas, DPP4i, pioglitazone, orlistat, and GLP1a was 85.35%, 74.95%, 68.32%, 60%, 39.16%, 9.08%, and 4.17%, respectively. However, 365, 970, and 104 patients were on one of 4 concerned medications (Group-1; 24.18%), dual MDT (Group-2; 64.28%), and triple/quadruple MDT (Group-3; 6.89%). Metformin with SGLT2i was most commonly used dual MDT (94.12%). Analysis according to weight-loss quartiles from 558 patients showed 6.9 kg weight-loss in the highest quartile. People losing maximum weight were significantly younger; had higher use of metformin, SGLT2i, GLP1, orlistat, and lower pioglitazone use; greatest HbA1c reduction (-1.3 vs. -0.3; quartile-1 vs. quartile -4; < 0.001); and significantly higher occurrence of HbA1c<5.7% (16.8% vs. 6.29%; quartile-1 vs. 4; < 0.001). Patients in Group-3 had the highest baseline BMI and maximum weight loss with highest number of patients with HbA1c<5.7% (19.44% vs. 10.34%; Group-3 vs. Group-1; < 0.001).

Conclusion: Greater weight loss with HbA1c reduction along with a greater number of patients attaining HbA1c <5.7% highlights that MDT is the way forward to tackle diabesity in India.

Citing Articles

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Dutta D, Nagendra L, Harish B, Sharma M, Joshi A, Hathur B Indian J Endocrinol Metab. 2024; 28(5):436-444.

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Orforglipron, a novel non-peptide oral daily glucagon-like peptide-1 receptor agonist as an anti-obesity medicine: A systematic review and meta-analysis.

Dutta D, Nagendra L, Anne B, Kumar M, Sharma M, Kamrul-Hasan A Obes Sci Pract. 2024; 10(2):e743.

PMID: 38414573 PMC: 10896246. DOI: 10.1002/osp4.743.

Observation on clinical effect of Huoxue-Jiangtang decoction formula granules in treating prediabetes: a randomized prospective placebo-controlled double-blind trial protocol.

Zhang P, Zeng L, Meng L, Li H, Zhao H, Liu D BMC Complement Med Ther. 2022; 22(1):274.

PMID: 36261813 PMC: 9580157. DOI: 10.1186/s12906-022-03755-2.

ESI Clinical Practice Guidelines for the Evaluation and Management of Obesity In India.

S V M, Nitin K, Sambit D, Nishant R, Sanjay K Indian J Endocrinol Metab. 2022; 26(4):295-318.

PMID: 36185955 PMC: 9519829. DOI: 10.4103/2230-8210.356236.

Reversal and Remission of T2DM - An Update for Practitioners.

Shibib L, Al-Qaisi M, Ahmed A, Miras A, Nott D, Pelling M Vasc Health Risk Manag. 2022; 18:417-443.

PMID: 35726218 PMC: 9206440. DOI: 10.2147/VHRM.S345810.

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