The <scp>DAPA‐DIET</scp> study: Metabolic response to Dapagliflozin combined with dietary carbohydrate restriction in patients with Type 2 Diabetes Mellitus and Obesity—A longitudinal cohort study

Hanson, Petra; Randeva, Harpal S.; Cuthbertson, Dan J; O'Hare, Paul; Parsons, Nicholas R.; Chatha, Kamaljit; Reidy, Gemma; Weickert, Martin O.; Barber, Thomas M.

doi:10.1002/edm2.381

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…A study of 24-week empagliflozin treatment with nutritional education showed significant decreases in body weight and improvement in blood glucose level without postprandial hunger sensation in the empagliflozin-treated group compared with the placebo group [ 30 ]. A 12-month observational study of dapagliflozin in combination with dietary carbohydrate restriction and intervention by specialist weight-management dietitians throughout the study period showed decreases in body weight and blood leptin level but no changes in appetite in patients with obesity and type 2 diabetes [ 31 ]. Taken together, previous research suggests that administration of oral SGLT2i combined with nutritional education may be an effective treatment that suppresses appetite.…”

Section: Discussionmentioning

confidence: 99%

Changes in daily intake of nutrients and foods including confectionery after the initiation of empagliflozin in Japanese patients with type 2 diabetes: a pilot study

Murayama,

Hosojima,

Kabasawa

et al. 2024

BMC Nutr

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Introduction It is unclear how dietary intake changes after sodium-glucose cotransporter 2 inhibitor (SGLT2i) treatment is started in patients with type 2 diabetes. Methods We performed a non-controlled, open-label study that enrolled 51 patients with type 2 diabetes. The patients were newly administered empagliflozin, and their dietary habits were examined using a self-administered diet history questionnaire at the beginning of the study and after 24 weeks. We investigated the association of changes in HbA1c and body weight with changes in energy, nutrient, and food group intakes. Results At 24 weeks after the start of the study, HbA1c improved significantly and body weight decreased. In the food group, only the intake of confectionery increased, and there were no significant differences in the association between changes in HbA1c and body weight and changes in energy, nutrient, and food group intakes after 24 weeks. However, a significant negative correlation was found between change in HbA1c after 4 weeks and change in energy intake after 24 weeks, and principal component analysis showed an association between change in HbA1c levels after 4 weeks and change in energy intake and some food group intakes including confectionery after 24 weeks. Conclusion In this study, after 24 weeks of treatment with empagliflozin, only intake of confectionery increased. Early assessment by dietitians after initiation of SGLT2i treatment might be important because our data suggested that the reduction in blood glucose levels after the start of empagliflozin was associated with a subsequent increase in energy intake. Trial registration University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) on September 5, 2016 (registration ID, UMIN000002309|| http://www.umin.ac.jp/ctr/).

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Section: Discussionmentioning

confidence: 99%

Changes in daily intake of nutrients and foods including confectionery after the initiation of empagliflozin in Japanese patients with type 2 diabetes: a pilot study

Murayama,

Hosojima,

Kabasawa

et al. 2024

BMC Nutr

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“…Of interest are also results of a human study. In the DAPA-DIET study, a 12-month cohort study in a secondary care setting, Hanson et al ( 15 ) explored the effect of dapagliflozin combined with an LCD on weight loss, energy expenditure and appetite in patients with T2DM and obesity. The authors found that the combination therapy of SGLT2i and LCD led to significant and substantial weight loss, and reduced serum leptin levels in study participants.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that the combination therapy of SGLT2i and LCD led to significant and substantial weight loss, and reduced serum leptin levels in study participants. Intriguingly, Hanson et al ( 15 ) suggested that the LCD intervention may curb carbohydrate cravings often associated with SGLT2i therapy, which may help to optimise sustainable weight loss.…”

Section: Discussionmentioning

confidence: 99%

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy

Kleissl-Muir,

Rasmussen,

Owen

et al. 2023

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium–glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple ‘traffic light’ style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced. Learning points Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium–glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.

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“…The DAPA-DIET study, evaluating dapagliflozin's impact on body weight in obese and diabetic patients, which has demonstrated a mean body fat mass loss of 9.9 kg over 12 months, but it has to be said that participants were on a diet with a limited amount of carbohydrates. Moreover, after 12 months of treatment, there was a significant reduction of mean serum leptin [66].…”

Section: Flozins and The Body Massmentioning

confidence: 91%

What Do We Know about Flozins: New, Pleiotropic Drugs

Wojciechowska,

Okopień

2023

Journal of Health Study and Medicine

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Civilization diseases affect more and more people globally. As a World Health Organization reports in 2016 more than 1.9 billion of adults were overweight and excess body mass is the leading risk factor for developing diabetes affecting approximately 422 million people worldwide (90% is DM2). It has seemed that the link between obesity, diabetes, and cardiovascular complications is a low-grade chronic inflammation that is observed in all tissues involved in energy homeostasis and is characterized by the activation of pro-inflammatory macrophages so-called M1. The increasing number of patients suffering from diabetes has challenged scientists to develop more and more powerful and pleiotropic antidiabetic drugs, which apart from better glycemia control will be able to decrease the total cardiovascular risk (a leading cause of death in diabetic patients). SGLT-2 inhibitors seem to show pleiotropic effects – cardioprotective, nephroprotective, and anti-inflammatory one.

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The DAPA‐DIET study: Metabolic response to Dapagliflozin combined with dietary carbohydrate restriction in patients with Type 2 Diabetes Mellitus and Obesity—A longitudinal cohort study

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 7 publications

References 32 publications

Changes in daily intake of nutrients and foods including confectionery after the initiation of empagliflozin in Japanese patients with type 2 diabetes: a pilot study

Changes in daily intake of nutrients and foods including confectionery after the initiation of empagliflozin in Japanese patients with type 2 diabetes: a pilot study

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy

What Do We Know about Flozins: New, Pleiotropic Drugs

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