Investigation for Daily Profile of Blood Glucose by the Administration of Canagliflozin and Xultophy (IdegLira)

Background: American Diabetes Association (ADA) presented 2022 guideline, and indicated the benefit of sodium-glucose transporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP-1RA). Xultophy is a combined agent of insulin degludec/liraglutide (IDegLira), which is recently clinically useful.
Patient and Method: The case is 72-year-old man with type 2 diabetes mellitus (T2DM). He has been treated by some oral hypoglycemic agents (OHAs) with unstable HbA1c levels.
Results: When HbA1c was 9.9% in 2018, his daily profile of blood glucose three times a day ranged 208-289 mg/dL. By starting canagliflozin, blood glucose decreased for 145-194 mg/dL. As HbA1c increased to 8.8% in 2021, blood glucose ranged 179-192 mg/dL. By starting Xultophy 12 doses per day, it decreased to normal level for 73-155 mg/dL. HbA1c was reduced to 6.7% half year later. Changes in eGFR showed the decrease from 80 to 51 mL/min/1.73 m2 during unstable HbA1c period in 2018-2019, and stable 50-60 mL/min/1.73 m2 during stable HbA1c period in 2020-2021 with Xultophy therapy.
Discussion: SGLT2i, GLP-1RA and Xultophy seem to be beneficial for cardiovascular and renal function. Furthermore, these agents seem to be adequate for diabetic patients with chronic kidney disease (CKD) and/or diabetic kidney disease (DKD).

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