Can ertugliflozin improve diabetes and blood pressure in patients who have heart disease?

This study looked at the ertugliflozin (Steglatro) for patients with type 2 diabetes (T2D) and heart disease. It found that ertugliflozin improved both blood glucose control, body weight, and blood pressure.

T2D is a condition in which the levels of glucose (sugar) in the blood are too high. T2D is related to obesity. People with T2D are at a higher risk of plaque building up in the arteries. This type of cardiovascular disease (CVD) increases the risk of heart attack and stroke.

Controlling blood glucose can manage complications of T2D and CVD. Insulin treatment can improve blood glucose control. However, it does not always fully control blood glucose. Also, insulin can cause weight gain, which can worsen T2D over time.

Oral diabetes medications can be used instead of or in addition to insulin. Sodium-glucose transporter 2 (SGLT2) inhibitors are one type of diabetes medication. Examples of this type of medication include empagliflozin (Jardiance) and dapagliflozin (Farxiga). These medications act on the kidneys, causing glucose to pass out of the body in the urine. SGLT2 inhibitors are effective at improving blood glucose control, and they do not cause weight gain. They also prevent kidney damage, which can be a long-term complication of diabetes.

Ertugliflozin is an SGLT2 inhibitor that was approved in the United States in 2017, and in Europe in 2018. Ertugliflozin can improve blood glucose control. However, it is not clear whether ertugliflozin can improve heart health for patients with both T2D and CVD.

This study included 1065 patients with both T2D and CVD. All of the patients were using insulin. However, their blood glucose was not completely controlled. Two-thirds of the patients were randomly assigned to take ertugliflozin in either a low (5 mg) or a high dose (15 mg). The remaining patients took a placebo. They were followed for 18 weeks.

Using ertugliflozin significantly improved blood glucose control. Glycated hemoglobin (HbA1c) is an estimate of blood glucose control over the previous 2 to 3 months. It measures what portion of hemoglobin in the blood has an attached molecule of sugar. Patients who used a low dose of ertugliflozin reduced their HbA1c by 0.58% compared to placebo. Those who used a high dose of ertugliflozin reduced their HbA1c by 0.65% compared to placebo.

At 18 weeks, more patients using ertugliflozin 5 mg (20.7%) and 15 mg (21.1%) reached a target HbA1c below 7% compared to those using a placebo (10.7%).

Patients who used a low dose of ertugliflozin lost an average of 1.6-1.9 kg more than the placebo group over 18 weeks. The medication also significantly reduced blood pressure. Systolic blood pressure (SBP) refers to the higher blood pressure after the heart beats. Arteries stiffened by plaque will have a higher SBP, and SBP is related to cardiovascular risk. Patients taking low-dose ertugliflozin had a reduction in SBP of 2.9 mmHg compared to placebo.

Women were significantly more likely to have yeast infections while using ertugliflozin. There was no increase in hypoglycemia (abnormally low blood glucose).

This study found that ertugliflozin can improve blood glucose and blood pressure, as well as body weight for patients with T2D and CVD.

This study was funded by Merck, the manufacturer of Steglatro.