Researchers compare the cardiovascular effectiveness and safety of GLP-1 agonists and SGLT-2 inhibitors in older adults with diabetes. Both sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) have been shown to have cardiovascular benefits in patients less than 65 years old. Current guidelines recommend initiating a GLP1RA or SGLT2i in patients with a high risk for cardiovascular disease, established ASCVD, chronic kidney disease (CKD), or heart failure. However, the effectiveness and safety have not been evaluated in geriatric patients, who compose most patients with type 2 diabetes. Older adults may have a higher incidence of adverse effects or altered outcomes due to polypharmacy, Medic GLP Website functional alterations due to aging, and comorbidities. Therefore, a cohort study was conducted to assess the cardiovascular effectiveness and safety in older adults with type 2 diabetes. Researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, identified 90,094 patients utilizing Medicare data from April 2013 to December 2016. Patients were included in the study if they were 66 years or older, had a diagnosis of type 2 diabetes, and were on either an SGLT2i (canagliflozin, dapagliflozin, or empagliflozin) or GLP1 RA (albiglutide, dulaglutide, exenatide, or liraglutide).
The study’s two primary outcomes were major adverse cardiovascular events (MACE), including myocardial infarction, stroke, cardiovascular death, and hospitalization for heart failure. The safety outcomes evaluated were risks of diabetic ketoacidosis, genital infections, fractures, lower-limb amputations, acute kidney injury, severe urinary tract infections, and mortality. An exposure propensity score (PS) was calculated to control differences in the baseline patient characteristics using a multivariable logistic regression model. SGLT2i use. The risk of bone fractures and severe urinary tract infections did not differ between SGLT2i and GLP1RA. No difference was also noted in the subgroup analysis results according to age, metformin use, and CKD history. However, patients with a CVD history had reductions in hospitalization for heart failure risk, cardiovascular death risk, and MedicGLP all-cause mortality with SGLT2i use compared to GLP1RA. This study’s limitations relate to the PS matching inability to adjust for all baseline characteristics, resulting in imbalances between both groups.
Furthermore, the higher use of canagliflozin and liraglutide than other SGLT2i and GLP1RA agents may affect generalizability to other medications used in these drug classes. Adverse safety effects associated with GLP1RA, such as acute pancreatitis and acute gallbladder/biliary disease, were also not evaluated, preventing a proper benefit-risk assessment in older adults. Future studies can include GLP1RA specific safety issues and have a more comprehensive SGLT2 and GLP1RA agents range. Overall, MedicGLP SGLT2i were associated with similar incidences of MACE, lower hospitalization rates for heart failure and an increased cardiovascular benefit in patients with a history of CVD compared to GLP1RA use. In older adults with type 2 diabetes, SGLT2i use had similar MACE incidence and lower hospitalization for heart failure than GLP-1 RA. SGLT2i was associated with a greater risk of diabetic ketoacidosis, amputation risk, genital infection risk, and a lower risk of acute kidney injury, with no differences in fractures and urinary tract infections. Future studies will need to explore GLP-1 RA specific adverse events in older adults /geriatric population to determine incidence and guide antihyperglycemic drug initiation. Patorno E, Pawar A, Bessette LG, et al. Comparative Effectiveness and Safety of Sodium-Glucose Cotransporter 2 Inhibitors Versus Glucagon-Like Peptide 1 Receptor Agonists in Older Adults.
Science continues to prove that the old adage "you are what you eat" is profoundly true. This is because you have trillions of microorganisms living in your gut, which are directly responsible for nearly every aspect of your health. These microbes make up what’s called your "gut microbiota." They are especially influential in determining your likelihood of gaining excessive weight, becoming obese, and developing obesity-related diseases like diabetes, heart disease, and premature death. The gut microbiome (the expressed genes of your gut microbiota) plays a major role in your metabolism through energy production, storage, and expenditure. So, it’s no surprise that science has found a strong connection between gut microbiome imbalance and metabolic syndrome. Yikes! If you have the wrong mix of microbes, it could be making it tough for you to get your health on track! Did you know: Scientists can actually look at your gut microbiome composition and tell with 90% accuracy if you are obese or lean. That’s pretty impressive, isn’t it?
1. Unable to lose weight and keep it off? 2. Struggling to fight cravings? 3. Sick of starving yourself for weight loss? 4. Baffled as to why no diet seems to really work for you? Depending on the composition of your gut microbiome, your microbes can either boost your health or weigh you down (figuratively and literally). The good news is this: You have control over these little guys with every bite you eat. Diet has the power to change the landscape of your gut microbiome. So, if you’ve tried multiple diets and MedicGLP can’t seem to get the results you want, it’s time to look into your gut microbiome.Will You Lose Weight Naturally on an Individualized Diet? If you’ve been struggling to lose weight and keep it off - it could be your gut microbiome. While Viome doesn’t guarantee weight loss, it has been an exciting result many of our customers have reported. "Fiona’s update day 37!