SGLT-2 Inhibitors and Body Composition in T2DM

New research found that SGLT-2 inhibitors revamp the body composition in T2DM by improving the body weight, body mass index, waist circumference, visceral fat area, subcutaneous fat area, percentage body fat, and fat mass reduction, but also reduce muscle mass. The study results were published in the journal PLOS ONE.

Type 2 diabetes mellitus (T2DM) is linked to sarcopenic obesity (SO). In evaluating T2DM and SO, factors like body composition measurement including body weight, body mass index, waist circumference, percentage body fat, fat mass, muscle mass, visceral adipose tissue, and subcutaneous adipose tissue, play an important role. Studies have demonstrated the weight reduction effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors. But SGLT-2 inhibitors have to be used cautiously due to the increased risk of sarcopenia. As there is uncertainty on the effect of SGLT-2 inhibitors on body composition in T2DM, Runzhou Pan et al conducted a meta-analysis of randomized controlled trials to evaluate the effect of SGLT-2 inhibitors on body composition in T2DM.

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Using keywords, PubMed, the Cochrane Library, Embase, and Web of Science databases were searched. Review Manager version 5.3 was used to carry out the statistical analyses. For continuous outcomes, weight mean difference (WMD), with 95% confidence intervals (CI) was used for comparison and regardless of heterogeneity, random effects model was applied. The heterogeneity of studies was evaluated by I² statistic. Funnel plots were used to assess the publication bias.

Key Findings:

• 18 studies with 1430 participants met the eligibility criteria for the meta-analysis.
• SGLT-2 inhibitors significantly reduced the following parameters:
  • Body weight (WMD: -2.73kg)
  • Body mass index (WMD: -1.13kg/m²)
  • Waist circumference (WMD: -2.20cm)
  • Visceral fat area (MD: -14.79cm²)
  • Subcutaneous fat area (WMD: -23.27cm²)
  • Fat mass (WMD: -1.16kg)
  • Percentage body fat (WMD: -1.50%)
  • Lean mass (WMD: -0.76kg)
  • Skeletal muscle mass (WMD: -1.01kg)

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Thus, when compared to other hypoglycemic agents, SGLT-2 inhibitors not only reduced BW, BMI, WC, VFA, SFA, PBF, FM, and LM but also had an adverse effect of reducing SMM to a greater extent. Further studies are needed to carry out an in-depth analysis of SGLT-2 inhibitors on skeletal muscle mass.

Further reading: Pan R, Zhang Y, Wang R, Xu Y, Ji H, Zhao Y. Effect of SGLT-2 inhibitors on body composition in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. PLOS ONE. 2022;17(12):e0279889. Published 2022 Dec 30. doi: 10.1371/journal.pone.0279889