We surveyed primary care physicians (n=10) and endocrinologists (n=10) to see how SGLT-2 inhibitors and the combo pills will be used and what the potential impact of usage with GLP-1 agonists may have.

The first SGLT-2 inhibitor, Invokana (JNJ), was approved last year for Type II Diabetes, and this year, another two were approved, Farxiga (AZN) and Jardiance (Boehringer, LLY). At the ADA meeting earlier this year, several KOLs noted the weight loss with these agents was on average similar to GLP-1 agonists, though one view was that the response to GLP-1 agonists was more variable, with some patients having more weight loss than seen with SGLT-2 inhibitors and some less.

First data from SGLT-2/DPP-IV inhibitor fixed dose combinations for Farxiga and Jardiance were also released at the ADA meeting, with weight loss similar to the individual SGLT-2 inhibitors. A1c reductions were better than the individual components, and while not additive, approached those of GLP-1 agonists. There was also data at the conference showing that the weight loss with an SGLT-2 inhibitor was appreciably less than what one might expect from the loss of glucose (and hence calories) in the urine, so combined usage with an appetite suppressant, like a GLP-1 agonist, could have synergistic effects.