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SGLT2 inhibitor provides greater weight loss benefits than metformin, gliptins

17 Feb 2019

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]

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Most Read Articles
20 May 2019

Dr Michael Lim, a senior consultant at the Paediatric Pulmonary and Sleep Division, National University Hospital, Singapore, speaks to Roshini Claire Anthony on the rare disease that is cystic fibrosis.

31 May 2019
Co-therapy with proton pump inhibitors (PPIs) in patients receiving low-dose anticoagulation and/or aspirin for stable cardiovascular disease confers no benefit for upper gastrointestinal events but may reduce bleeding due to gastroduodenal lesions, a study has shown.
Laura Kho Sui San , 29 May 2019
Anxiety becomes a pathological disorder when it occurs for no detectable reason, persists and interferes with daily activities like work performance and relationships.
Jairia Dela Cruz, 10 Jun 2019
Statins appear to exert neuroprotective effects in diabetic prostate cancer patients receiving androgen deprivation therapy (ADT), with a recent study showing that the drug confers benefit for the risk of dementia. The benefit is greater with higher statin adherence and intensity.