Sodium–glucose cotransporter 2 inhibitor and sarcopenia in a lean elderly adult with type 2 diabetes: A case report

Abstract

A 70-year-old woman with type 2 diabetes was admitted to Gifu University Hospital, Gifu, Japan, because of ketosis. She was diagnosed with type 2 diabetes at age 49 years and started insulin therapy at age 57 years, which restored glycemic control. Insulin therapy was discontinued and oral antidiabetes drugs, including sodium-glucose cotransporter 2 inhibitor dapagliflozin, were initiated at age 69 years. Thereafter, her bodyweight declined from 40.0 kg to 29.8 kg in 12 months; glycated hemoglobin remained >8.0%. On admission to our hospital, her laboratory tests and computed tomography scan showed ketosis, insulinopenia, and the presence of dehydration and bacterial pneumonia. She also lost substantial bodyweight and developed sarcopenia. The current case shows the importance of patient assessment before sodium-glucose cotransporter 2 inhibitor initiation in the elderly.

Sodium‐glucose co‐transporter 2 inhibitors on weight change and cardiometabolic profiles in individuals with overweight or obesity and without diabetes: A meta‐analysis

“…The effect of SGLT‐2 inhibitors on sarcopenia in individuals with overweight or obesity and without diabetes cannot be concluded because of limited studies. In fact, some other studies found that SGLT‐2 inhibitors have no association or a protective effect on T2DM‐induced sarcopenia 36–38 . Further studies are needed to assess the effect of SGLT‐2 inhibitors on body composition in with overweight or obesity and without diabetes.…”

“…Moreover, the potential association between the use of SGLT‐2 inhibitors and sarcopenia (loss of skeletal muscle mass) have caused concern possibly because glucagon‐mediated proteolysis is induced by SGLT‐2 inhibition 35,36 . Three studies reported changes in the fat‐free mass of the participants 23,27,29 .…”

Polypharmacy and Malnutrition Management of Elderly Perioperative Patients with Cancer: A Systematic Review

“…Consequently, they reduce the uptake of glucose and amino acids into muscle and promote protein breakdown [61]. Dapagliflozin, ipragliflozin, and empagliflozin have been shown to decrease muscle mass and skeletal muscle mass index [62][63][64][65]. However, further studies are needed to determine the frequency of the occurrence of SGLT-2 inhibitor-related sarcopenia and whether SGLT-2 inhibitors cause diabetes-related sarcopenia, as clinical data are limited.…”

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

“…Rehabilitation pharmacotherapy aims to help frail older or disabled people achieve the highest level of function and QOL [ 23 ▪ ]. For example, a sodium–glucose cotransporter 2 inhibitor resulted in the development of malnutrition and sarcopenia in type 2 diabetes patients [ 24 ], and anticholinergic and sedative drug burden was associated with poorer performance of ADL and postural balance in stroke patients [ 25 ]. Moreover, decreased use of potentially inappropriate medications during hospitalization can improve ADL [ 26 ].…”