Effect of Add-On Therapy of Dapagliflozin and Empagliflozin on Adipokines in Type 2 Diabetes Mellitus

Abstract

Background:The alteration of adipokine secretion leads to the development of insulin resistance or impaired function of insulin in type 2 diabetes with obesity. The main objective of the study was to evaluate the effect of add-on therapy of dapagliflozin and empagliflozin on visceral fat-associated adipokines in inadequately controlled overweight and obese type 2 diabetic patients on metformin monotherapy. Methods:The study included 60 participants diagnosed with type 2 diabetes mellitus with overweight or obesity. The blood samples were taken before starting first-line therapy with metformin, 12 weeks after starting metformin therapy and 12 weeks after starting add-on therapy. The biochemical variables were analyzed using Cobas ® 6000 analyzer. Hemoglobin A1c (HbA1c) level was measured with highperformance liquid chromatography (HPLC). Serum adipokines were estimated with enzyme-linked immunosorbent assay (ELISA). Results:The mean adiponectin level was significantly elevated with add-on therapy using dapagliflozin and empagliflozin (P < 0.001). The mean fatty-acid binding protein 4 (FABP4), retinol-binding protein 4 (RBP4) and visfatin levels were reduced considerably (P < 0.001). The mean HbA1c, fasting plasma glucose (FPG) and postprandial blood glucose (PPBG) levels were reduced significantly with add-on therapy (P < 0.001). Lipid profile and creatinine were also altered significantly with the add-on therapy (P < 0.001).Conclusions: Add-on therapy of dapagliflozin and empagliflozin are beneficial to control the adipokines that regulate the visceral fat in overweight and obese type 2 diabetic patients. The effective therapeutic target to control adipokines with metabolic variables reduces body weight, obesity, cardiovascular risk and renal disease in type 2 diabetes.

Effect of empagliflozin versus linagliptin on body composition in Asian patients with type 2 diabetes treated with premixed insulin

“…SGLT2 inhibitors induce body weight loss not only through glycosuria and enhanced energy expenditure, but also through increased β-oxidation of fatty acids from activation of the adenosine monophosphate-activated protein kinase (AMPK) pathway, as well as changes in adiponectin and leptin expression 14 . Empagliflozin may improve adipocyte dysfunction in visceral adipose tissue, resulting in the decrease of leptin, visfatin, and plasminogen activator inhibitor-1, as well as increase of adiponectin levels, which effectively contributes to fat lipolysis and reduces visceral fat 15 , 16 .…”