Study Highlights Potential of newer Diabetic Drugs

Research led by the University of Manchester and Manchester University NHS Foundation Trust has been able to link two types of diabetes drugs with lower chances of potentially fatal heart problems in people with type 2 diabetes that do not have established heart disease.

The study of English and Welsh data compared two newer types of medication, SGLT2 inhibitors and GLP-1 receptor agonists (GLP-1RAs) with more traditional therapies such as metformin and sulphonylureas to assess potential heart failure risk profile. The study showed that the odds of developing heart failure was 51% lower for people using SGLT2 inhibitors, 18% lower for GLP-1RAs users and 57% lower for people using both drugs. The odds of having a heart attack or stroke was 18% lower for SGLT2 inhibitors, 7% lower for GLP-1RAs and 30% lower for them given in combination.

Although SGLT2 inhibitors have been licensed since 2012 and GLP-1RA therapies since 2005, doctors routinely prescribe more traditional therapies and the researchers concluded that cost, regular prescribing practices and limited emphasis in current clinical management guidelines, may explain why these drugs are prescribed less frequently.

The study(1) funded by Diabetes UK, was a collaboration with King’s College London, The University of Liverpool, Keele University and the University of Glasgow. The team linked primary care data from the Clinical Practice Research Datalink (CPRD) and the Secure Anonymised Information Linkage (SAIL) Databank to hospital and mortality records.

Co-author Professor Martin Rutter, a researcher at The University of Manchester and Honorary Consultant Physician at the Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, part of MFT, said: “There are around 4 million people with type 2 diabetes in the UK and sadly more than one in three of these people will die from cardiovascular disease.

“The good news is that SGLT2 inhibitors and GLP-1RA drugs not only control diabetes, but they also reduce the risk of developing serious cardiovascular events such as heart attack or stroke. And that could save thousands of lives every year - not to mention the avoidance of chronic illness in those who survive heart attacks and strokes. The protective effect of these two types of medication can be seen as soon as patients start to receive them - though the longer they take them, the greater the protection.”

Co-author Professor Darren Ashcroft, a researcher at The University of Manchester, said: “The mechanism by which these drugs provide their protective effects is an active area of research. However, their life-saving effects may be partly explained by their beneficial effects on weight loss and the fact that they don’t cause low blood sugar levels (hypoglycaemia), which can be harmful to the cardiovascular system.”

Lead author Dr Alison Wright, a statistician at The University of Manchester, said: “While GLP-1RA and SGLT2 inhibitors are expensive treatments, we believe the cost-effectiveness of such treatment options in terms of primary prevention should be seriously examined. This is because 80% of diabetes care costs are related to managing complications, with the largest contributor being cardiovascular disease. We believe these data make a strong case for trials evaluating the efficacy and cost-effectiveness of these interventions and their combination in lower risk people with type 2 diabetes.”

Published in Diabetes Care

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