SGLT-2 inhibitors and GLP-1 analogues are in the right place as second line therapies in type 2 diabetes, a study presented at conference has concluded.

The research presented by endocrinologist Dr David Hoffman from the Australian Diabetes Informatics Group (DINGO) set out to test the efficacy and durability of SGLT-2 inhibitors with GLP-1 analogues in people with type 2 diabetes.

Dr Hoffman told delegates that since the loosening of PBS restrictions around the prescribing of the drugs there had been a proliferation in their use as add on therapies, leaving clinicians confused about which of the two drug classes to add first to treatment regimens.

Their analysis involved over 5,000 patients, of whom 11% had taken a GLP-1 analogue and 16% an SGLT-2 inhibitor, who were seen by endocrinologists over a four-year period.

They discovered that SGLT-2 inhibitors performed slightly better than GLP-1 analogues in terms of HbA1c and weight loss and patients tended to stay on them longer (2.1 years vs 1.5 years).

Dr Hoffman noted that this finding was due to the class being better tolerated by men.

At least one third of patients ceased either class of drug due to adverse reactions, Dr Hoffman added.

“In real-life conditions the addition of SGLT-2 inhibitors may be an overall more effective and durable treatment than the addition of a GLP-1 analogue,” he concluded.

However, he noted that as neither class was as durable as the established first line therapies they “deserved to keep their place as second line therapies”.