SGLT inhibitors on weight and body mass: A meta‐analysis of 116 randomized‐controlled trials

Cheong, Alex Jia Yang; Teo, Yao Neng; Syn, Nicholas; Ong, How Ting; Ting, Adriel Z. H.; Chia, Alfred; Chong, Elliot Yeung; Chan, Mark Y; Lee, Chi‐Hang; Lim, Amanda Yuan Ling; Kong, William; Wong, Raymond Cc; Chai, Ping; Sia, Ching‐Hui

doi:10.1002/oby.23331

Cited by 36 publications

(18 citation statements)

References 44 publications

(46 reference statements)

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“…The glucosuric effect of SGLT2-i is associated with weight loss ( Figure 2 ). In a recent meta-analysis, treatment with SGLT2-i, compared with placebo, generated a significant mean weight reduction of −1.79 kg (95% CI: −1.93; −1.66, p < 0.001) [ 94 ]. In patients with HF, SGLT2-i reduced body weight by −1.36 kg; (95% CI: −1.68; −1.03; p < 0.001) [ 83 ].…”

Section: Current Antidiabetic Drugs and The Influence Of Hypertensionmentioning

confidence: 99%

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

et al. 2023

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Hypertension poses a significant burden in the general population, being responsible for increasing cardiovascular morbidity and mortality, leading to adverse outcomes. Moreover, the association of hypertension with dyslipidaemia, obesity, and insulin resistance, also known as metabolic syndrome, further increases the overall cardiovascular risk of an individual. The complex pathophysiological overlap between the components of the metabolic syndrome may in part explain how novel antidiabetic drugs express pleiotropic effects. Taking into consideration that a significant proportion of patients do not achieve target blood pressure values or glucose levels, more efforts need to be undertaken to increase awareness among patients and physicians. Novel drugs, such as incretin-based therapies and renal glucose reuptake inhibitors, show promising results in decreasing cardiovascular events in patients with metabolic syndrome. The effects of sodium-glucose co-transporter-2 inhibitors are expressed at different levels, including renoprotection through glucosuria, natriuresis and decreased intraglomerular pressure, metabolic effects such as enhanced insulin sensitivity, cardiac protection through decreased myocardial oxidative stress and, to a lesser extent, decreased blood pressure values. These pleiotropic effects are also observed after treatment with glucagon-like peptide-1 receptor agonists, positively influencing the cardiovascular outcomes of patients with metabolic syndrome. The initial combination of the two classes may be the best choice in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors because of their complementary mechanisms of action. In addition, the novel mineralocorticoid receptor antagonists show significant cardio-renal benefits, as well as anti-inflammatory and anti-fibrotic effects. Overall, the key to better control of hypertension in patients with metabolic syndrome is to consider targeting multiple pathogenic mechanisms, using a combination of the different therapeutic agents, as well as drastic lifestyle changes. This article will briefly summarize the association of hypertension with metabolic syndrome, as well as take into account the influence of antidiabetic drugs on blood pressure control.

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Section: Current Antidiabetic Drugs and The Influence Of Hypertensionmentioning

confidence: 99%

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

et al. 2023

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“…While there is an increase in the relative risk of adverse reactions (mycotic genital infection, UTI, and lower limb amputation), the absolute benefit currently outweighs the risk. Several meta-analyses involving the above trials have demonstrated a positive weight loss outcome with SGLT2i compared to placebo [ 48 , 49 ]. However, to date, there are no published trials of SGLT2i specifically in patients with obesity.…”

Section: Randomized Controlled Trials On Sodium-glucose Cotransporter...mentioning

confidence: 99%

Recent advances in the treatment of patients with obesity and chronic kidney disease

2023

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Obesity is a chronic disease characterised by excess adiposity, which impairs health. The high prevalence of obesity raises the risk of long-term medical complications including type 2 diabetes and chronic kidney disease. Several studies have focused on patients with obesity, type 2 diabetes and chronic kidney disease due to the increased prevalence of diabetic kidney disease. Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease showed renoprotective effects. However, further research is critical to address the treatment of patients with obesity and chronic kidney disease to lessen morbidity. Key message Obesity is a driver of chronic kidney disease, and type 2 diabetes, along with obesity, accelerates chronic kidney disease. Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease demonstrate the improvement of renal outcomes. There is a need to address the treatment of patients with obesity and CKD to lessen morbidity.

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“…Using these parameters, we will have 90% power to detect statistically signi cant differences between the groups at α 0.05. This estimation was based on the available evidence for body weight reduction using Liraglutide 3mg daily (13) or Semaglutide 1mg weekly (14) , Dapagli ozin 10mg daily (15) and the weight loss achieved at the DDI when standard care is provided in people with T1D.…”

Section: Sample Size {14}mentioning

confidence: 99%

Obesity Treatments to Improve Type 1 Diabetes. The OTID trial Protocol for obesity treatments to improve Type 1 Diabetes. The OTID trial

Al-Ozairi,

Narula,

Miras

et al. 2023

Preprint

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• Background The guidelines of the American Diabetes Association and European Association for the Study of Diabetes suggest that patients with obesity type 2 diabetics, and chronic kidney disease need either glucagon-like peptide 1 receptor analogues or sodium-glucose cotransporter-2 inhibitors. If neither achieve metabolic control, then the recommendation is to combine both drugs. The evidence base for combining glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors are not well researched, and hence the impact of the guidelines are limited. The aim of this randomized controlled trial is to test the impact of the combination of glucagon-like peptide 1 receptor analogues / sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage, in patients with type 1 diabetes and chronic kidney disease. In addition, we will explore associated changes in metabolic pathways with each of the treatments used in this randomized controlled trial. • Methods In this 6-month randomized control trial, 60 participants aged between 21–65 years, with a body mass index above 25kg/m2 and type 1 diabetics with chronic kidney disease will be randomized to receive one of five possible treatments 1) Standard care (control), 2) glucagon-like peptide 1 receptor analogues alone, 3) sodium-glucose cotransporter-2 inhibitors alone, 4) combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors, 5) combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors with intensive lifestyle advice. The primary objective will be the percentage change in total body weight from baseline at 6 months. The secondary objectives are to compare change in glycaemia, blood pressure, dyslipidaemia, albuminuria, proportion of participants reaching weight loss of ≥ 5%, ≥ 10% and ≥ 15%, change in BMI (kg/m2) from baseline and change in waist circumference (cm). All the experiments will be conducted at the Dasman Diabetes Institute after approval from the local research and ethics committee. • Discussion The present randomized controlled trial aims to investigate the impact of the combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage in patients with type 1 diabetes mellitus and chronic kidney disease, as well as exploring associated changes in metabolic pathways with each of the treatments used. This study addresses the current gap in the evidence base regarding the combination of these two drugs, which is particularly relevant given the American Diabetes Association and European Association for the Study of Diabetes guidelines recommending their combined use for patients with obesity, type 2 diabetes, and chronic kidney disease who do not achieve metabolic control with either drug alone. Trial registration ClinicalTrials.gov Identifier: NCT0539030

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SGLT inhibitors on weight and body mass: A meta‐analysis of 116 randomized‐controlled trials

Cited by 36 publications

References 44 publications

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

Links between Metabolic Syndrome and Hypertension: The Relationship with the Current Antidiabetic Drugs

Recent advances in the treatment of patients with obesity and chronic kidney disease

Obesity Treatments to Improve Type 1 Diabetes. The OTID trial Protocol for obesity treatments to improve Type 1 Diabetes. The OTID trial

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