The advisory board resolution on the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in type 2 diabetes

Type 2 diabetes is characterized by increasing incidence and prevalence all-over the world. Current therapeutic management of type 2 diabetes is complex and is based not only on glycemic control, but also on cardiovascular and renal risks reduction. In previous years the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) increased in Russian Federation. Some manufacturers of the most widely used GLP-1 RA reported the supply decline in several countries. On Advisory board with participation of the Russian Endocrinology Association members the topics of SGLT2i and GLP-1 RA use in type 2 diabetes were discussed. The experts made conclusion that the decrease in access to GLP-1 RA does not pose serious risk for treatment of type 2 diabetes patients. SGLT2i show benefits in risk reduction of HF and CKD progression compering to GLP-1 RA, and in general show comparable efficacy in risk reduction of ACVD outcomes.  SGLT2i show less glycemic efficacy in comparison with GLP-1 RA, and their replacement may need adding antidiabetic agents from other groups.

1. Demograficheskij ezhegodnik Rossii. 2021; Stat. Sb. D 31. Moscow: Rosstat-M; 2021. 256 p. (In Russ.).

2. Dedov II, Shestakova MV, Mayorov AYu, et al. Standards of specialized diabetes care. Diabetes Mellitus. 2021;24(S1):1-235 (In Russ.)]. doi: https://doi.org/10.14341/DM12802

3. Arnold SV, Tang F, Cooper A, et al. Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER. BMC Endocr Disord. 2022;22(1):111. doi: https://doi.org/10.1186/s12902-022-01026-2

4. Dedov II, Mokrysheva NG, Shestakova MV, et al. Saharnyj diabet v Rossijskoj Federacii: dinamika jepidemiologicheskih pokazatelej po dannym Federal’nogo registra saharnogo diabeta na 01.01.2023 goda. Diabetes mellitus. 2023 (in print). (In Russ.).

5. El Sayed NA, Aleppo G, Aroda VR, et al. American Diabetes Association. Standards of Care in Diabetes — 2023. Diabetes Care. 2023;46(S1):S1-S4.

6. Rossing P, Caramori ML, Chan JCN, et al. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5):S1-S127. doi: https://doi.org/10.1016/j.kint.2022.06.008

7. Kawai Y, Uneda K, Yamada T, et al. Comparison of effects of SGLT-2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in type 2 diabetes mellitus patients with/without albuminuria: A systematic review and network meta-analysis. Diabetes Res Clin Pract. 2022;(183):109146. doi: https://doi.org/10.1016/j.diabres.2021.109146

8. Das SR, Everett BM, Birtcher KK, et al. 2020 Expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes. J Am Coll Cardiol. 2020;76(9):1117-1145. doi: https://doi.org/10.1016/j.jacc.2020.05.037