SGLT2 inhibitors not cost-effective for glycemic management
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SGLT2 inhibitors provide limited glycemic management benefits and may not be cost-effective for most people with type 2 diabetes, according to a study published in the Journal of Diabetes and Its Complications.

Researchers studied the use of all hypoglycemic agents in periods before and after introduction of SGLT-2 inhibitors in the USA by repeated cross sectional analysis to initially assess improvement in HbA1c control among patients with type 2 diabetes and hypertension. They sought to identify changes in glucose management related to the availability of the SGLT-2 inhibiting agents. They hypothesized that patients transitioned to SGLT-2 inhibitor-based therapy represented a higher risk group that derived benefits in terms of Hba1c control.

Deidentified records of patients seen at least twice during the relevant time periods were examined. Records required all of the following: demographic information of gender, age, height, weight, BMI, HbA1c, eGFR, blood pressure, smoking status and completed medication lists.

-- 10,191 patients met criteria for analysis, 7769 seen in period 1 and 6576 in period 2. 4625 patients were seen in both periods.

-- The group of patients defined by SGLT-2 use had significantly higher BMI and HbA1c.

-- Notable shifts in medication use were observed as SGLT-2 use increased from none to 14%. Increased use of GLP-1 agents (16.0 to 23.8%), insulin (56.1 to 60.5%) and statins (78.4 to 81.5%) and statistically significant decreases in use of biguanides (69.5 to 66.3%) and sulfonylurea compounds (44.7 to 39.4%), thiazolidinediones (13.6 to 3.4%) and diuretics (32.4 to 28.9%) were observed.

-- Statistically significant decreases of HbA1c (7.9 to 7.8%), BMI (32.5 to 32.1), eGFR (80.6 to 77.5?ml/min) and increased systolic blood pressure (130 to 132?mm?Hg) were documented.

Conclusively, in the absence of glycemia treatment resistance or clinical heart failure SGLT-2 inhibitor use may not be cost effective. Enthusiasm for use of SGLT-2 inhibition should be based upon long-term cardiorenal protection rather than short-term glycemia control given limited impact upon HbA1c levels in our tertiary care type 2 diabetes population.