Abstract

ASSESSMENT OF INCRETIN MIMETICS AND SGLT2i THERAPY ON PATIENTS WITH DM TYPE 2 AND ASSOCIATED COMORBIDITIES

Dr. Mohammed Ashfaq Hussain, Dr. Ahrar Ahmed Feroz, *Syeda Hafsa Hussaini, Fatima Fovadi Hussain and Mohammed Sarfaraz Hussain

ABSTRACT

Background: Type 2 diabetes (DMT2) is a long-term metabolic disease typified by elevated blood sugar levels and insulin resistance. As major worldwide health burden it affects more than 422 million people and is linked to several consequences. Comorbidities are prevalent in diabetes which exacerbates the clinical picture and raises the risk of retinopathy, nephropathy, cardiovascular disease and neuropathy. These comorbidities frequently include intricate interactions between underlying pathophysiological processes and metabolic abnormalities. The three main goals of current DMT2 treatment plans are weight loss, comorbidity management and glycaemic control. Conventional medicines do have several drawbacks such as insufficient glycaemic control and a restricted ability to addresscomorbidities. In recent years, incretin mimetics and SGLT2i drugs are being widely used as second-line treatment to cure diabetes type 2.[1]Aim:1. To evaluate and compare the efficacy and safety of incretin mimetics and SGLT2i compared to the first-line therapy for DM2 and their impact on the associated comorbidities.Objectives:1. To assess the impact of incretin mimetics and SGLT2i on the RBS, FBS and HbA1c of diabetic patients as compared to standard therapy. 2. To assess the safety and impact of incretin mimetics and SGLT2i on the comorbid conditions in patients with DM2.3. To assess the quality of life in patients with DM2 while taking incretin mimetics and SGLT2i.Method: The study is a prospective observational study conducted in Diabetes Mellitus Type 2 patients having other comorbid complications. The enrolment was carried out between July 2023 and January 2024. Altogether 350 Indian patients diagnosed to have Diabetes Mellitus Type 2 were enrolled and are included in the study. The sample size of the study population was calculated based on the overall prevalence of Diabetes Mellitus Type 2 in the Indian population. An estimate of that magnitude with 95% confidence limits required a sample size of 385. With around 10% allowance for any dropouts, the calculated sample was 350. Results: The study found that all three treatment groups (incretin mimetics, SGLT2i, and combination therapy) significantly improved blood sugar control and other parameters like weight, blood pressure, and lipids. Combination therapy yielded the best results, with average reductions in random blood sugar (178 mg/dL), fasting blood sugar (116 mg/dL), HbA1c (6.7%), weight (7.3 kg), systolic blood pressure (128 mmHg), and diastolic blood pressure (81 mmHg). Incretin mimetics followed closely, while SGLT2i alone had the smallest improvements. The most common side effects were nausea (25% with incretin mimetics) and headaches (22% with SGLT2i). The six-month therapy program brought positive improvements, with 27% reporting excellent present health and 24% very good. While managing the disease remained challenging (34% sleep impact, 36% exercise impact), social interactions (47% little impact) were less affected. Insulin administration proved to be difficult for 45% (70% experiencing pain), and 60% needed medication reminders. However, 50% were satisfied with therapy cost-effectiveness. Comorbidities impacted quality of life for 35% (moderately for 39% emotionally), highlighting the need for further support. Patient information leaflets offered promise for enhancing quality of life alongside pharmacist intervention. Conclusion: This study found that incretin mimetics, SGLT2 inhibitors, and their combination effectively improved blood sugar control and associated parameters in DMT2 patients with comorbidities. Combination therapy yielded the best results, while all options significantly improved blood sugar, weight, blood pressure, and the lipid profile of the patients. Gastrointestinal issues and upper body discomfort were the most common side effects. Overall, these drugs are safe and effective for managing DMT2 and its comorbidities.Need for the Study: Rarely does type 2 diabetes occur on its own. Co-morbidities affecting patient outcomes include obesity, nephropathy, cardiovascular disease, and cognitive decline. For the purpose of improving patient treatment, it is essential to comprehend how SGLT2i and incretin mimetics impact these co-morbidities in addition to glycaemic management. Although advantages beyond glycaemic control are touted by both medication groups, these benefits differ. Incretin mimetics could give cardioprotective and weight-loss benefits, whereas SGLT2is may excel in avoiding renal disease and heart failure. Which agent is more suitable for particular co-morbidity profiles can be determined by the study. Through an investigation of the distinct effects of every medication class on different co-morbidities, this study can lead to more individualized treatment plans. This would enable optimizing therapeutic benefits and avoiding potential negative effects while customizing therapy to meet the needs of each individual patient. It is necessary to explore the beneficial impact that these drugs may have on comorbid conditions to reduce the need to take several medications that contribute to the risks of polypharmacy.

Keywords: Diabetes Mellitus Type 2, Obesity, Weight Gain, Hypertension, Hyperthyroidism, Cardiovascular Complications, Dyslipidaemia, Incretin Mimetics, SGLT2i, Diabetic Neuropathy, Diabetic Nephropathy, Quality of Life.