SAT-812 Can Sglt-2 And Glp-1 Ra Combination Therapy Facilitate Insulin Discontinuation In Patients With Long-standing Uncontrolled Type 2 Diabetes?

Abstract Disclosure: A.A. Shaghouli: None. S. Daou: None. R. Aranky: None. Amna Shaghouli, MD, FRCPC1,2 Rola Aranky, MSc1, Sara Daou RDGlycemia Clinic, KuwaitAbstract Aim: Progressive loss of β-cell function in type 2 diabetes (T2D) can be regained with good glycemic/metabolic and weight control. Current guidelines offer no clear pharmacological recommendation for patients who fail Multiple Daily Injections of insulin (MDI). We tested the hypothesis that MDI can be stopped in patients with uncontrolled T2D by adding either a glucagon-like peptide-1 receptor agonist (GLP-1RA), ± sodium/glucose-cotransporter 2 inhibitors (SGLT2-I) and/or other oral glucose-lowering medications. “Oral glucose-lowering medications” Methods: A 48-months, retrospective interventional study at Glycemia Clinic, Kuwait, enrolled 103 patients with T2D (uncontrolled on MDI [HbA1c ≥6.5%]) and obesity. MDI regimen was either switched to GLP-1RA, SGLT2-I and/or other oral agents. At the end of study, patients were divided into STOP and ON groups as per their insulin intake status. Results: At baseline, the participants had a mean HbA1c of 8.81% ± 1.68%, T2D duration of 22 ± 9.73 years, BMI of 36.08 ± 9.06 kg/m², and a mean insulin therapy duration of 11 ± 7 years with mean TDD of Insulin of 82.48 ± 36 Units/Day. At month 48, there were 49 patients in STOP group (no insulin) and 54 patients in ON group (once daily basal insulin). The mean percent decrease in HbA1c was 1.7% in STOP group (p <0.0001) and 1% in ON group (p <0.001). Both groups, (STOP vs. ON), showed significant reductions in weight (–13.1% [p < 0.0001] vs. –10.5% [p < 0.002]) and systolic blood pressure (p < 0.0001 vs. p < 0.01). Conclusions: This long-term study shows that insulin can be discontinued in nearly half of long-standing T2D patients using GLP-1RA, SGLT2-I, oral agents, and lifestyle changes, emphasising weight reduction. For those requiring insulin, simplifying to once-daily basal dosing improved outcomes. Further studies should explore broader applicability and sustained β-cell recovery strategies. References: •American Diabetes Association. (2025). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2025. Diabetes Care, 48(Supplement 1), S181. https://doi.org/10.2337/dci23-0031•Taylor, R., Al-Mrabeh, A., & Sattar, N. (2019). Understanding the mechanisms of reversal of type 2 diabetes. The Lancet Diabetes & Endocrinology, 7(9), 726–736. https://doi.org/10.1016/S2213-8587(19)30076-2•Castellana, M., Cignarelli, A., Brescia, F., Perrini, S., Natalicchio, A., Laviola, L., & Giorgino, F. (2019). Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis. Scientific Reports, 9(1), 19351. https://doi.org/10.1038/s41598-019-55524-w Presentation: Saturday, July 12, 2025