SGLT2 inhibitor provides greater weight loss benefits than metformin, gliptins
In patients with type 2 diabetes (T2D), sodium-glucose cotransporter 2 (SGLT2) inhibitor monotherapy, particularly canagliflozin, exerts greater effects on weight compared with metformin and dipeptidyl peptidase 4 (DPP-4) inhibitors or gliptins, according to the results of a meta-analysis.
Researchers searched multiple online databases for relevant randomized controlled trials evaluating the effect of different SGLT2 inhibitors vs other glucose-lowering medications on weight in T2D patients. The studies had to be ≥12 weeks in length and assess change in weight from baseline, ideally reporting the proportion of patients achieving a ≥5-percent weight reduction.
The meta-analysis included 29 randomized controlled trials with a low risk of bias, involving 11,999 patients. Researchers used the DerSimonian-Laird and Bayesian Markov chain Monte Carlo random effects models.
Pooled data revealed that SGLT2 monotherapy led to a mean weight loss ranging from −2.26 kg (95 percent credible interval, −2.71 to −1.76) with canagliflozin 300 mg to −0.79 kg (−1.54 to −0.05) with ipragliflozin 25 mg when compared with metformin.
Relative to linagliptin and sitagliptin, the mean weight loss ranged from −3.17 kg (−3.67 to −2.57) with canagliflozin 300 mg to −0.93 kg (−1.92 to 0.05) with ipragliflozin 25 mg.
Among other SGLT2 inhibitors, canagliflozin 300 mg yielded the greatest effect on weight with a probability of 99.44 percent.
SGLT2 inhibitors also increased the number of patients achieving ≥5-percent weight loss, with their effect on weight reduction correlated with treatment dosage.
Currently, the mechanism through which SGLT inhibitors affect weight is a topic of great interest. Evidence suggests that selective SGLT2 inhibitors mainly exert their effects on weight loss by lowering the reabsorption of glucose, leading to an increase in urinary glucose excretion. [Clin Ther 2015;37:1150-1166]