Flozin Plus GLP-1 Agonist for Most Diabetes Patients is not recommended

Adlyxine (ad-LIKS-een, lixisenatide) and Ozempic (oh-ZEM-pik, semaglutide) join the crowded field of GLP-1 agonists.

This is how they compare

A1C lowering. Expect Ozempic, Bydureon (exenatide ER), Trulicity (dulaglutide), or Victoza(liraglutide) to lower A1C by about 1.5% when added to metformin…versus about 1% with Adlyxine or Byetta (exenatide).

Weight loss. Ozempic reduces weight by about 4 kg…compared to 2 to 3 kg with the others.

CV risk reduction. Ozempic may reduce CV risk in type 2 patients already at high CV risk…but so far Victoza is the only GLP-1 agonist shown to reduce both CV risk and CV death.

Dosing frequency. Bydureon, Ozempic, and Trulicity are injected subcutaneously once WEEKLY…compared to once DAILY for Adlyxine or Victoza…or TWICE daily for Byetta.

Side effects. We know all GLP-1 agonists can cause nausea but improves over time.

Ozempic is the only GLP-1 agonist with a warning about retinopathy complications. Patients with existing retinopathy are at higher risk.

Metformin is still first for type 2 diabetes.

If an add-on is needed for CV patients, try Victoza or the “flozin” Jardiance(empagliflozin)…they reduce CV risk and CV death.

References

• Lancet Diabetes Endocrinol 2018;6(5):370-81
• Diabetes Ther 2018;9(3):919-26
• Diabetes Obes Metab 2017;19(10):1353-62
• Diabetes Care 2018;41(Suppl 1):S73-S85
• Diabetes Care 2018;41(Suppl 1):S86-S104