Impact of Dapagliflozin and Dulaglutide on Metabolic Health in T2DM

The management of metabolic health is crucial, particularly for individuals with type 2 diabetes mellitus (T2DM) and metabolic-dysfunction associated steatotic liver disease (MASLD). These conditions are linked to increased cardiovascular risks and liver complications. Recent research has focused on the effects of two classes of medications: glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study aimed to assess the impacts of dapagliflozin (an SGLT-2i) and dulaglutide (a GLP-1RA) on cardiovascular function and liver metabolism over a 12-month period. In this real-world study, 62 patients with T2DM and MASLD were analyzed, with 21 receiving dapagliflozin, 21 dulaglutide, and 20 dipeptidyl peptidase-4 inhibitors (DPP-4i). The results showed significant improvements across several cardiovascular and metabolic markers. After 12 months, all groups exhibited reductions in glycosylated hemoglobin (HbA1c) and body mass index (BMI), with p-values indicating strong statistical significance (P < 0.001). Notably, both dapagliflozin and dulaglutide led to reductions in central systolic blood pressure (cSBP), pulse wave velocity (PWV), and improvements in coronary flow reserve (CFR) and left ventricular global longitudinal strain (GLS). Dulaglutide outperformed dapagliflozin and DPP-4i in enhancing GLS (22.6% vs. 8.5% and 5.9%, P = 0.015) and improving glycocalyx thickness (P = 0.037). The findings suggest that both medications can significantly enhance cardiovascular health and reduce hepatic steatosis in patients with T2DM. For individuals managing these conditions, the implications are profound. Incorporating either dapagliflozin or dulaglutide into a treatment plan could lead to better control of blood sugar levels, weight loss, and improved heart health. Patients should consult with their healthcare providers to determine the most suitable option based on their specific health profiles. In terms of biomarkers, this study relates closely to several key indicators of metabolic health, including HbA1c, which reflects long-term glucose control, and liver health markers like controlled attenuation parameter (CAP) and liver stiffness (E). Monitoring these biomarkers can provide insights into the effectiveness of treatment and overall metabolic status. In conclusion, the study highlights the potential of SGLT-2i and GLP-1RA in improving metabolic health outcomes for individuals with T2DM and MASLD. As metabolic health continues to be a growing concern, these findings underscore the importance of targeted pharmacological interventions alongside lifestyle modifications to achieve optimal health outcomes.