Arora Gunjan, Hashmi Sulman, Kaeli Samson, Azad Sarah, Batra Jaskaran, Perugu Vijaya Deepika, Davis Clifton, Desouza Cyrus V
Department of Endocrinology, Omaha Nebraska VA Medical Center, Omaha, NE 68105, USA.
Department of Endocrinology, University of Nebraska Medical Center, Omaha, NE 68198, USA.
J Clin Med. 2025 Jun 10;14(12):4092. doi: 10.3390/jcm14124092.
SGLT2 inhibitors (SGLT-2i) and GLP1 receptor agonists (GLP-1 RA) are recommended as the first line therapy for the management of type 2 diabetes mellitus (T2DM), particularly in patients with chronic kidney disease (CKD), cardiovascular disease (CVD), and heart failure (HF). Despite their established efficacy, there is limited evidence available to predict which subset of patients will respond favorably to them. We conducted this study to identify baseline characteristics to predict the response to therapy with SGLT-2i and GLP-1 RA. A retrospective analysis of the medical records was conducted at the Veteran Affairs Medical Center (VAMC) in Omaha, Nebraska, USA. Veterans who had completed 6-12 months of treatment with SGLT-2i or GLP-1 RA were included. Favorable treatment outcomes were a ≥0.5% reduction in glycosylated hemoglobin (HbA1c) or a ≥5% reduction in body weight; and those who achieved both outcomes were classified as adequate responders. Patients in the GLP-1 RA group had 2.11 (95% CI: 1.45, 3.07) times the odds of achieving an adequate response as compared to patients in the SGLT-2i group in the unadjusted analysis, < 0.001. HbA1c > 8% and older age was significantly associated with achieving an adequate response. Treatment with GLP-1 RA should be considered in Veterans with these characteristics.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）和胰高血糖素样肽-1受体激动剂（GLP-1 RA）被推荐作为2型糖尿病（T2DM）管理的一线治疗药物，尤其是对于患有慢性肾脏病（CKD）、心血管疾病（CVD）和心力衰竭（HF）的患者。尽管它们的疗效已得到证实，但预测哪些患者亚组对其反应良好的证据有限。我们开展这项研究以确定预测对SGLT-2i和GLP-1 RA治疗反应的基线特征。在美国内布拉斯加州奥马哈市的退伍军人事务医疗中心（VAMC）对病历进行了回顾性分析。纳入了完成6至12个月SGLT-2i或GLP-1 RA治疗的退伍军人。良好的治疗结果是糖化血红蛋白（HbA1c）降低≥0.5%或体重降低≥5%；同时实现这两个结果的患者被归类为充分应答者。在未调整分析中，与SGLT-2i组患者相比，GLP-1 RA组患者实现充分应答的几率是其2.11倍（95%置信区间：1.45，3.07），P<0.001。HbA1c>8%和年龄较大与实现充分应答显著相关。对于具有这些特征的退伍军人应考虑使用GLP-1 RA进行治疗。
