COMPARISON OF GLYCEMIC CONTROL ACTIVITY OF SGLT2 INHIBITORS AND SULPHONYLUREAS IN PATIENTS OF IHD

The prevalence of Diabetes mellitus (DM) has escalated in the previous decades and is among the major risk factors for developing cardiovascular diseases.1,2 Multiple factors play role in progression of DM towards micro and macrovascular complications. However, poor glycemic control is a main contributor towards the adverse disease outcomes and has been of prime importance in decision making regarding antidiabetic medications. Methodology: It was a longitudinal cross-sectional study conducted in CMH Jhelum using non-probability convenient sampling technique. Patients having DM and IHD for atleast 1year and with inadequate glycemic control with metformin were selected and analyzed according to demographic details, duration of DM & IHD, therapy group (SGLT2 inhibitors/SU), dosage regimen, incidence of hypoglycemia, comorbidities, history of coronary intervention, baseline and 3-monthly fasting and post-prandial glucose, HbA1c and metabolic profile. Chi square test was applied to find significant difference between both groups and p-value of <0.05 was considered significant. Results:  Among total of 70 patients, 35 patients were divided into each group (Sulphonylureas vs SGLT inhibitors). Both groups had comparable baseline profiles which included gender [males: 17(48.57%) vs  16(45.71%), females: 18(51.43%) vs 19(54.29%) ], duration of diabetes (8.37 ± 2.59 vs 8.86 ± 2.43 years, p=0.417) and IHD (7.63 ± 2.68 vs. 7.46 ± 2.52 years, p=0.854), history of coronary intervention (48.57% vs. 54.29%, p=0.632), hypoglycemia (34.29% vs. 48.57%, p=0.225), hypertension (51.43% vs. 34.29%, p=0.147), and dyslipidemia (48.57% vs. 45.71%, p=0.811). Comparison of both groups in glycemic control activity showed almost comparable reduction in fasting blood glucose in both groups ((132.20±19.79 vs 138.69±18.56, p-value=0.143) at 3-monthly follow-up from baseline (159.80±19.52 vs 161.74±18.57, p-value=0.778). However, there was significant difference in reduction in post-prandial glucose (169.40±20.09 vs 159.43±21.45, p-value 0.052) from baseline (198.31±19.71 vs 196.91±21.52, p-value=-0.733) and HbA1c (7.49±0.63 vs 7.05±0.64, p-value=0.006) from baseline (8.26±0.61 vs 8.09±0.59, p-value=0.212) at 3-monthly follow-up. Conclusion: SGLT2 inhibitors have greater impact in reducing HbA1c and post-prandial blood glucose as compared to SU but further research is needed to elaborate this comparison. The prevalence of Diabetes mellitus (DM) has escalated in the previous decades and is among the major risk factors for developing cardiovascular diseases.1,2 Multiple factors play role in progression of DM towards micro and macrovascular complications. However, poor glycemic control is a main contributor towards the adverse disease outcomes and has been of prime importance in decision making regarding antidiabetic medications. Methodology: It was a longitudinal cross-sectional study conducted in CMH Jhelum using non-probability convenient sampling technique. Patients having DM and IHD for atleast 1year and with inadequate glycemic control with metformin were selected and analyzed according to demographic details, duration of DM & IHD, therapy group (SGLT2 inhibitors/SU), dosage regimen, incidence of hypoglycemia, comorbidities, history of coronary intervention, baseline and 3-monthly fasting and post-prandial glucose, HbA1c and metabolic profile. Chi square test was applied to find significant difference between both groups and p-value of <0.05 was considered significant. Results:  Among total of 70 patients, 35 patients were divided into each group (Sulphonylureas vs SGLT inhibitors). Both groups had comparable baseline profiles which included gender [males: 17(48.57%) vs  16(45.71%), females: 18(51.43%) vs 19(54.29%) ], duration of diabetes (8.37 ± 2.59 vs 8.86 ± 2.43 years, p=0.417) and IHD (7.63 ± 2.68 vs. 7.46 ± 2.52 years, p=0.854), history of coronary intervention (48.57% vs. 54.29%, p=0.632), hypoglycemia (34.29% vs. 48.57%, p=0.225), hypertension (51.43% vs. 34.29%, p=0.147), and dyslipidemia (48.57% vs. 45.71%, p=0.811). Comparison of both groups in glycemic control activity showed almost comparable reduction in fasting blood glucose in both groups ((132.20±19.79 vs 138.69±18.56, p-value=0.143) at 3-monthly follow-up from baseline (159.80±19.52 vs 161.74±18.57, p-value=0.778). However, there was significant difference in reduction in post-prandial glucose (169.40±20.09 vs 159.43±21.45, p-value 0.052) from baseline (198.31±19.71 vs 196.91±21.52, p-value=-0.733) and HbA1c (7.49±0.63 vs 7.05±0.64, p-value=0.006) from baseline (8.26±0.61 vs 8.09±0.59, p-value=0.212) at 3-monthly follow-up. Conclusion: SGLT2 inhibitors have greater impact in reducing HbA1c and post-prandial blood glucose as compared to SU but further research is needed to elaborate this comparison.