Weight Outcomes With Empagliflozin as Compared With Liraglutide in Veterans With Type 2 Diabetes Mellitus

摘要

Background: Glucagon-like peptide-1 agonists and sodium glucose cotransporter 2 inhibitors are associated with weight loss and improved cardiovascular outcomes, and are increasingly used in pharmacotherapy for type 2 diabetes mellitus (T2DM). Objectives: To compare weight loss outcomes of empagliflozin and liraglutide in patients with T2DM and overweight/obesity not yet prescribed insulin but requiring additional pharmacotherapy to improve glycemic control. Methods: This is an observational, multisite, cohort study of veterans with T2DM prescribed liraglutide or empagliflozin. Participants were prescribed either empagliflozin or liraglutide prior to November 1, 2017, had a hemoglobin A(1C) (A1C) >= 7.0%, had a body mass index >= 27 kg/m(2), and were not treated with insulin at baseline. The primary outcome was change in weight after 1 year using multiple regression. Secondary outcomes were the proportion achieving >= 5% weight loss and change in A1C. Results: Weight loss was not significantly different between groups: -2.17 kg (95% CI: -2.91 to -1.42) in the liraglutide group (n = 298) and -2.81 kg (95% CI: -3.43 to -2.20) in the empagliflozin group (n = 247; P > 0.05). After adjusting for covariates, this effect remained nonsignificant. There was no difference in change in A1C between liraglutide (-0.83%; 95% CI: -1.05% to -0.62%) and empagliflozin (-0.71%; 95% CI: -0.89% to -0.53%; P > 0.05). Conclusions and Relevance: There was no significant difference in weight outcomes after 1 year in veterans treated with liraglutide versus empagliflozin. Because both medications did show modest weight loss, both remain good options for patients needing an additional medication to improve glycemic control that is at least weight neutral.