SGLT2 inhibitors in the treatment of diabetes and weight influence, the experience of a Portuguese primary care unit
DOI:
https://doi.org/10.32385/rpmgf.v39i3.13641Keywords:
Diabetes mellitus, Sodium-glucose transporter 2 inhibitors, Body weight, Primary careAbstract
Introduction: Weight loss in diabetic patients can be associated with cardiovascular risk reduction. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have beneficial effects in the reduction of cardiovascular risk and are approved for the treatment of diabetes. Additionally, iSGLT2 is associated with a weight loss of approximately 2 kg in the first six months of treatment. In this study, we report the experience of a Portuguese primary care unit with this class and evaluate the effects on weight, waist circumference, and glycemic control during 12 months of follow-up.
Methods: This is an observational retrospective study. Patients with diabetes under treatment with SGLT2i who completed 12 months of follow-up were included. The exclusion criteria included: therapeutic changes and medical or surgical complications. The patients were evaluated at zero, six, and 12 months after the SGLT2i institution. The variables analyzed included weight, waist circumference, and glycated hemoglobin.
Results: One hundred and eighty-seven patients were included. The mean age was 65 ± 10.4 years old, and the majority was male (62.0%). The average duration of diabetes was 9 ± 7.4 years. Most patients were under therapy with dapagliflozin (65.8%) and the rest with empagliflozin (34.2%). Weight loss was significant between zero- and six-month follow-up (p<0.001) and between six and 12 months (p=0.01), with reductions of 2.3 ± 0.2kg and 0.5 ± 0.2kg respectively. Waist circumference and glycated hemoglobin reduced significantly from zero to six months, 1.5 ± 0.3cm (p<0.001) and 0.9 ± 0.8% (p<0.001), respectively. Both variables had no significant changes between six and 12-month follow-ups.
Conclusion: The use of iSGLT2 in the treatment of patients with diabetes in a real-life study showed significant improvement in glycemic control, weight loss, and waist circumference.
Downloads
References
Sohail E, Ahsan T, Ghaus S, Aijaz W. SGLT 2 inhibitors, glycemic control, weight loss and safety profile in patients with type 2 diabetes, at Medicell Institute (MIDEM). Pak J Med Sci. 2021;37(1):87-92.
Raposo JF. Diabetes: factos e números 2016, 2017 e 2018. Rev Port Diabetes. 2020;15(1):19-27.
Silva-Nunes J, Aguiar C, Birne R, Branco P, Calado J, Matos P, et al. Empagliflozina e a nova era no tratamento da diabetes tipo 2: para além do controlo glicémico [Empagliflozin and the new age in the treatment of type 2 diabetes: beyond glycemic control]. Rev Port Diabetes. 2017;12(1):9-22. Portuguese
Thewjitcharoen Y, Yenseung N, Malidaeng A, Nakasatien S, Chotwanvirat P, Krittiyawong S, et al. Effectiveness of long-term treatment with SGLT2 inhibitors: real-world evidence from a specialized diabetes center. Diabetol Metab Syndr. 2017;9:96.
Monteiro P, Aguiar C, Matos P, Silva‐Nunes J, Birne R, Branco P, et al. Effect of empagliflozin beyond glycemic control: cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease. Rev Port Cardiol. 2019;38(10):721-35.
Lazzaroni E, Nasr MB, Loretelli C, Pastore I, Plebani L, Lunati ME, et al. Anti-diabetic drugs and weight loss in patients with type 2 diabetes. Pharmacol Res. 2021;171:105782.
Pereira MJ, Eriksson JW. Emerging role of SGLT-2 inhibitors for the treatment of obesity. Drugs. 2019;79(3):219-30.
Apovian CM, Okemah J, O’Neil PM. Body weight considerations in the management of type 2 diabetes. Adv Ther. 2019;36(1):44-58.
Janež A, Fioretto P. SGLT2 inhibitors and the clinical implications of associated weight loss in type 2 diabetes: a narrative review. Diabetes Ther. 2021;12(8):2249-61.
Bolinder J, Ljunggren Ö, Kullberg J, Johansson L, Wilding J, Langkilde AM, et al. Effects of dapagliflozin on body weight, total fat mass, and regional adipose tissue distribution in patients with type 2 diabetes mellitus with inadequate glycemic control on metformin. J Clin Endocrinol Metab. 2012;97(3):1020-31.
Ribola FA, Cançado FB, Schoueri JH, De Toni VF, Medeiros VH, Feder D. Effects of SGLT2 inhibitors on weight loss in patients with type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci. 2017;21(1):199-211.
Feder D, Gouveia MR, Govato TC, Nassis CZ. SGLT2 Inhibitors and the mechanisms involved in weight loss. Curr Pharmacol Rep. 2020;6:346-53.
Zaccardi F, Webb DR, Htike ZZ, Youssef D, Khunti K, Davies MJ. Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis. Diabetes Obes Metab. 2016;18(8):783-94.
Sasaki T, Sugawara M, Fukuda M. Sodium-glucose cotransporter 2 inhibitor-induced changes in body composition and simultaneous changes in metabolic profile: 52-week prospective LIGHT (Luseogliflozin: the components of weight loss in Japanese patients with type 2 diabetes mellitus) study. J Diabetes Investig. 2019;10(1):108-17.
Saisho Y. SGLT2 inhibitors: the star in the treatment of type 2 diabetes? Diseases. 2020;8(2):14.
Mearns ES, Sobieraj DM, White CM, Saulsberry WJ, Kohn CG, Doleh Y, et al. Comparative efficacy and safety of antidiabetic drug regimens added to metformin monotherapy in patients with type 2 diabetes: a network meta-analysis. PLoS One. 2015;10(4):e0125879.
Schork A, Saynisch J, Vosseler A, Jaghutriz BA, Heyne N, Peter A, et al. Effect of SGLT2 inhibitors on body composition, fluid status and renin–angiotensin–aldosterone system in type 2 diabetes: a prospective study using bioimpedance spectroscopy. Cardiovasc Diabetol. 2019;18(1):46.
Ferrannini G, Hach T, Crowe S, Sanghvi A, Hall KD, Ferrannini E. Energy balance after sodium-glucose cotransporter 2 inhibition. Diabetes Care. 2015;38(9):1730-5.
Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C,et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America's health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care. 2007;30(6):1647-52.
Li J, Gong Y, Li C, Lu Y, Liu Y, Shao Y. Long-term efficacy and safety of sodium-glucose cotransporter-2 inhibitors as add-on to metformin treatment in the management of type 2 diabetes mellitus: a meta-analysis. Medicine. 2017;96(27):e7201.
Neeland IJ, McGuire DK, Chilton R, Crowe S, Lund SS, Woerle HJ, et al. Empagliflozin reduces body weight and indices of adipose distribution in patients with type 2 diabetes mellitus. Diab Vasc Dis Res. 2016;13(2):119-26.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Portuguese Journal of Family Medicine and General Practice

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.