Medications
Increasing prescribing of SGLT-2 inhibitors and GLP1 receptor agonists
One of the key initiatives in the Michigan Collaborative for Type 2 Diabetes is increasing prescribing of SGLT2 inhibitors and GLP1 receptor agonists. These medications improve glucose control, decrease mortality and adverse cardiovascular events, slow progression of chronic kidney disease, & support weight loss.
WHAT ARE SODIUM GLUCOSE COTRANSPORTER-2 INHIBITORS (SGLT2-I)?
SGLT2-Is are a class of glucose-lowering drugs that work by preventing the reabsorption of glucose from the blood that's filtered by the kidneys, therefore facilitating glucose excretion in the urine. SGLT2-I are widely used to treat patients with type 2 diabetes who are not well controlled on metformin alone. SGLT2-Is have the added benefit of protecting the heart and kidney health through the reduction of cardiovascular events and slowing of renal failure progression. SGLT2-Is also help patients lose weight.
WHAT ARE GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS (GLP-1 RAS)?
GLP-1 RAs are a class of glucose lowering drugs that work by stimulating the release of insulin by the pancreas after eating, inhibiting release of glucagon by the pancreas, which prevents the liver from releasing stored sugar into the bloodstream. GLP-1 RAs also slow glucose absorption into the bloodstream by slowing gastric emptying after eating. GLP-1 RAs significantly improve cardiovascular and renal outcomes, as well as help patients lose weight.
WHY SGLT2S AND GLP1RAS
In order of intensification, the paradigm of care for type 2 diabetes treatment historically has been diet and exercise, followed by Metformin, and then polypharmacy with basal insulin. Advances in care and scientific evidence in the last 20 years has provided a firm foundation that this paradigm is no longer the best course of treatment for patients with type 2 diabetes and in fact leads to further disease progression as well as adverse outcomes and complications.
Innumerable scientific studies have shown that there are far better options than the paradigm discussed above. Two new classes of medications, Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) represent much more effective second line treatments after Metformin alone. These classes of medications both significantly reduce glucose levels, reduce glycemic variability, and result in clinically significant weight loss. Weight loss from these medications represents a juxtaposition in clinical trajectory from disease worsening to reversing the underlying cause of type 2 diabetes.
See the evidence