Pioglitazone/Exenatide/SGLT-2 inhibitor combination therapy versus insulin therapy in patients with poorly controlled type 2 diabetes

Abstract

Aims: We aimed to investigate the changes in glycemic status and beta cell function in type 2 diabetes mellitus (T2DM) patients with poor glycemic control despite receiving basal/bolus insulin therapy when switched from insulin therapy to combination therapy [exenatide/pioglitazone/sodium glucose cotransporter 2 inhibitor (SGLT-2i)]. Methods: A retrospective examination was made of the data of 64 patients, aged >18 years, diagnosed with T2DM, who were being followed up in the endocrinology outpatient clinic and were switched from basal/bolus insulin therapy to triple combination therapy. At the time of the patients changing to combination therapy, the glycosylated hemoglobin (HbA1c) value was ≥8.5% and fasting c peptide value was within the normal reference range. The anthropometric data of the patients, and glycemic and biochemistry values with modified homeostastis model assessment β (HOMA-β) levels were compared before the combination therapy and at 6 months after. Results: Compared to the baseline values, a decrease was seen after 6 months in the values of body weight (89.6±5.8 vs. 83.8±3.6, p=0.015), body mass index (BMI) (38.3±2.7 vs. 33.5±1.9, p=0.011), and waist circumference (105.6±8.8 vs. 99.7±6, p=0.027). A decrease was determined in fasting blood glucose (FBG) (197±27.3 vs. 129±13.1, p<0.01) and HbA1c (9.8±1.6 vs. 8.1±1.1, p<0.01) values, and an increase in the HOMA-β value [233 (187.5, 282.3) vs. 318 (272.1, 365.2), p<0.001]. Conclusion: T2DM is a complex metabolic disease with more than one disorder in the pathogenesis, so it is difficult to control the disease in the long term with a single drug class. The use of drugs in a combined form, which will allow weight loss, have a positive effect on insulin resistance and improve beta cell function, without causing hypoglycemia, can achieve a better and sustainable glycemic and metabolic status.

Keywords

• Diabetes mellitus
• exenatide
• piogitazone
• SGLT-2

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