Patient Perspectives on the Use of GLP-1RA and SGLT2 Inhibitors in Type 1 Diabetes in Clinical Practice

Use of adjuvant therapies with GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) in T1DM is not uncommon. We explored users’ perspectives on perceived benefits and side effects with these therapies.

Methods:

We conducted a structured telephone interview of adult patients with T1DM who were ever treated with a GLP-1RA or SGLT2i for >3 months at University of Texas Southwestern (Dallas, TX) and Raszeja Hospital (Poznań, Poland). Patients were identified via query of electronic medical records with manual confirmation of T1DM diagnosis. Interview questions were open-ended with responses grouped within predefined categories.

Results:

We interviewed 68 people with T1DM who used GLP-1RA and 82 who used SGLT2i. GLP-1RA users were 73.5% female, 86.8% white, 45±13 years. SGLT2i users were 54.9% female, 90.2% white, 45±13 years. Median (IQR) exposure to GLP-1RA and SGLT-2i was 24.0 (30.5) and 15.7 (24.4) months, respectively; 58.8% and 69.5% were on therapy at time of interview. Most common reasons reported for treatment initiation were: improved glycemic control [42/68 (61.8%) vs 67/82 (81.7%) for GLP-1RA and SGLT2i users], weight loss and/or appetite suppression [35/68 (51.4%) vs 19/82 (23.2%)], reduced insulin requirement [9/68 (13.2) vs 9/82 (11%)], and decrease in glucose variability [4/68 (5.9%) vs 17/82 (20.7%)]. Most people (86.8% GLP-1RA and 89.0% SGLT2i users) reported ≥1 benefit attributed to these therapies. Most commonly perceived benefits from the therapy were: improved glycemic control [40/68 (58.8%) vs 68/82 (82.9%), for GLP-1RA and SGLT2i users], weight loss and/or appetite suppression [43/68 (63.2%) vs 25/82 (30.5%)], reduced insulin requirement [19/68 (27.9%) vs 28/82 (34.1%)], and reduced glucose variability [8/68 (11.8%) vs 22/82 (26.8%)]. Side effects perceived to be related to the therapy were more commonly reported by GLP-1RA vs SGLT2i users (63.2% vs 36.6%); 57.4% of GLP-1RA users experienced gastrointestinal side effects while 20.8% of SGLT2i users reported urinary tract and/or mycotic infections. DKA was reported by 4 (4.9%) SGLT2i users and no GLP-1RA user. No episodes of pancreatitis were reported. Of all GLP-1RA users, 14/68 (22.6%) discontinued therapy due to side effects vs 9/82 (11.0%) of SGLT2i users. Of those not currently on product, 60.7% GLP-1RA vs 56.0% SGLT2i prior users were willing to reinitiate the respective therapy.

Discussion/Conclusion:

Most patients with T1DM treated with adjuvant therapy with GLP-1RA or SGLT2i report benefits and are willing to continue such therapy. While GLP-1RA users reported more side effects, many would consider therapy re-initiation. DKA remains a clinical concern in SGLT2i users and they should be closely monitored.