Is it safe to start GLP-1 and SGLT2 at 52 for my diabetes?

Question

Hello doctor,

I am a 52-year-old woman with poorly controlled type 2 diabetes. My most recent HbA1c was 9.1 percent, measured earlier this month. Despite being on Metformin (a biguanide) and Glipizide (a sulfonylurea), my blood sugar levels remain consistently high. I am also overweight, feel constantly tired, and experience frequent urinary tract infections.

I am particularly concerned about potential side effects, especially since I have recurrent urinary tract infections.

Could these infections worsen with the use of SGLT2 (sodium-glucose co-transporter 2) inhibitors?
Would it be advisable to start newer medications such as GLP-1 (glucagon-like peptide-1) receptor agonists or SGLT2 inhibitors in my case?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

An HbA1c(glycated hemoglobin) of 9.1 percent, along with symptoms such as fatigue and weight gain, clearly indicates that your current medications, Metformin (a biguanide) and Glipizide (a sulfonylurea), are not providing adequate blood sugar control. You are indeed justified in exploring newer and more effective treatment options.

GLP-1(glucagon-like peptide-1) receptor agonists (such as semaglutide) offer significant HbA1c reduction with the added benefit of weight loss, which would be particularly helpful in your case. They also carry a very low risk of hypoglycaemia (low blood sugar). Side effects such as nausea and gastrointestinal discomfort can occur, but these are often temporary and usually not severe.

SGLT2 (sodium-glucose co-transporter 2) Inhibitors (such as Dapagliflozin and Canagliflozin) also contribute to HbA1c reduction, although generally to a lesser extent than GLP-1 receptor agonists. They are especially beneficial for patients with underlying cardiovascular or kidney conditions.

However, given your history of recurrent urinary tract infections, SGLT2 Inhibitors may not be the ideal choice for you. These medications increase glucose excretion through the urine, which can potentially worsen or trigger urinary infections. That said, they can still be used with caution if you are able to maintain excellent personal hygiene and monitor for early signs of infection, seeking prompt treatment when needed.

Based on your profile, overweight, poorly controlled type 2 diabetes, and a tendency for recurrent urinary tract infections, a GLP-1 Receptor Agonist may be the safer and more effective option. It not only helps reduce HbA1c but also supports weight loss, giving you a dual benefit.

Additional advice:

If you begin therapy with a GLP-1 receptor agonist, you may eventually need to discontinue Glipizide (a Sulfonylurea) to avoid the risk of hypoglycaemia. It is also important to have your kidney functions checked through tests such as blood urea and serum creatinine, and to evaluate your urinary tract health before initiating any new medication.

I hope this helps.

Thank you.