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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
Elaine Soliven, 20 May 2020
Early treatment with a triple antiviral combination of lopinavir-ritonavir, ribavirin, and interferon beta-1b significantly shortens the duration of virus shedding and reduces symptoms in patients with mild-to-moderate COVID-19 compared with lopinavir-ritonavir only, according to a recent study.
Pearl Toh, 26 Sep 2019
The Singapore Health Sciences Authority (HSA) has recalled eight brands of ranitidine products containing trace amounts of the nitrosamine impurity NDMA*, which is a potential human carcinogen.
Roshini Claire Anthony, 27 May 2020

The use of a vaginal cleansing intervention prior to Caesarean delivery reduced the incidence of surgical site infections (SSIs), according to a study presented at ACOG 2020. However, the addition of intravenous (IV) azithromycin prophylaxis had no added impact on SSI rates. 

Jairia Dela Cruz, 27 Mar 2020
Use of antioxidants for treating male factor infertility appears to be of little benefit, improving neither semen parameters nor DNA integrity, according to the results of the Males, Antioxidants and Infertility (MOXI) trial.