Kidney and Metabolic Benefits by Adding GLP-1 Agonists and/or SGLT2 Inhibitors on Metformin in Obese Type 2 Diabetes (T2DM) Patients: 24-Month Real-World Data from Both Urban and Rural Clinics

Objective: Assessment of the nephro-metabolic effects of GLP-1 agonists (Group A), SGLT-2 inhibitors (Group B) and both (Group C) in obese patients under metformin therapy with inadequate glycemic control. Materials and Methods: 253 patients with T2DM on metformin with a HbA1c > 7.0%. Results: Group A: reduction of HbA1c at 5.9±0.4% (95% C.I. of difference 1.63-3.03, p<0.001), reduction in body weight 7.1±5.5Kg (95% C.I. 4.98-9.26, p<0.001), ALT (mg/dL) reduced by 8.7±3.1, (p=0.04), reduction of Urine Albumin to Creatinine Ratio (UACR) by 25.0±40.8 (p=0.003) and increase of the estimated GFR (CKD-EPI formula) by 10.4±10.6, (p<0.001). Group B: reduction of HbA1c at 6.26±0.42% (95% C.I. of difference 0,59- 1.04 (p<0.001), reduction in body weight by 3.9±2.2Kg (95% C.I. 2.93-4.89 p<0.001), ALT reduced by -9.6±17.3 (p=0.02), UACR reduction by 36.2±70.2 (p=0.025) and eGFR increase 4.2±14.0 mL/mgCreat (p=0.18). Group C: major reduction of HbA1c by 1.9±1.0% (95% C.I. 1.10-2.09, p<0.001), body weight reduction by 10.6±5.7Kg 995% C.I. 7.97-13.28 p<0.0010, ALT reduction by -15.9±14.8 (p=0.04), UACR reduction by -29.9±31.9 (p<0.001) and eGFR increase by 8.3±10.5 (p=0.002). Conclusions: Triple combination therapy with metformin - GLP1-analog - SGLT2-inhibitor has the greatest effectiveness in weight loss and in improving liver biochemistry. The renal improvement seen with these drugs appears to be driven by a decrease in UACR for SGLT-2-inhibitors and an increase in eGFR for GLP1-analogues in this retrospective 24-month study. Disclosure I. Zoupas: None. A. Papazafiropoulou: None. M. Xenou: None. D. Lygnos: None. E. Fousteris: None.