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Kishi S, Kadoya H, Kashihara N. Treatment of chronic kidney disease in older populations. Nat Rev Nephrol 2024:10.1038/s41581-024-00854-w. [PMID: 38977884 DOI: 10.1038/s41581-024-00854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/10/2024]
Abstract
As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.
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Affiliation(s)
- Seiji Kishi
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroyuki Kadoya
- Department of General Geriatric Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kashihara
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan.
- Kawasaki Geriatric Medical Center, Kawasaki Medical School, Okayama, Japan.
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Zhang Y, Zhang K, Huang S, Li W, He P. A review on associated factors and management measures for sarcopenia in type 2 diabetes mellitus. Medicine (Baltimore) 2024; 103:e37666. [PMID: 38640276 PMCID: PMC11029968 DOI: 10.1097/md.0000000000037666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 04/21/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia, insulin resistance, and insufficient insulin secretion. Sarcopenia, as a new complication of diabetes, is characterized by the loss of muscle mass and the progressive decline of muscle strength and function in T2DM patients, which has a serious impact on the physical and mental health of patients. Insulin resistance, mitochondrial dysfunction, and chronic inflammation are common mechanisms of diabetes and sarcopenia. Reasonable exercise training, nutrition supplement, and drug intervention may improve the quality of life of patients with diabetes combined with sarcopenia. This article reviews the relevant factors and management measures of sarcopenia in T2DM patients, in order to achieve early detection, diagnosis, and intervention.
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Affiliation(s)
- Yi Zhang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemeng Zhang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sui Huang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhan Li
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping He
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xie T, Zhao LJ. Synthetic approaches and clinical application of small-molecule inhibitors of sodium-dependent glucose transporters 2 for the treatment of type 2 diabetes mellitus. Eur J Med Chem 2024; 269:116343. [PMID: 38513341 DOI: 10.1016/j.ejmech.2024.116343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
Sodium-dependent glucose transporters 2 (SGLT2) inhibitors are a class of small-molecule drugs that have gained significant attention in recent years for their potential clinical applications in the treatment of type 2 diabetes mellitus (T2DM). These inhibitors function by obstructing the kidneys' ability to reabsorb glucose, resulting in a rise in the excretion of glucose in urine (UGE) and subsequently lowering blood glucose levels. Several SGLT2 inhibitors, such as Dapagliflozin, Canagliflozin, and Empagliflozin, have been approved by regulatory authorities and are currently available for clinical use. These inhibitors have shown notable enhancements in managing blood sugar levels, reducing body weight, and lowering blood pressure in individuals with T2DM. Additionally, they have exhibited potential advantages in decreasing the likelihood of cardiovascular incidents and renal complications among this group of patients. This review article focuses on the synthesis and clinical application of small-molecule SGLT2 inhibitors, which have provided a new therapeutic approach for the management of T2DM.
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Affiliation(s)
- Tong Xie
- First People's Hospital of Shangqiu, Henan Province, Shangqiu, 476000, China.
| | - Li-Jie Zhao
- The Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, United States.
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Yabe D, Shiki K, Homma G, Meinicke T, Ogura Y, Seino Y. Efficacy and safety of the sodium-glucose co-transporter-2 inhibitor empagliflozin in elderly Japanese adults (≥65 years) with type 2 diabetes: A randomized, double-blind, placebo-controlled, 52-week clinical trial (EMPA-ELDERLY). Diabetes Obes Metab 2023; 25:3538-3548. [PMID: 37622398 DOI: 10.1111/dom.15249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
AIM Use of sodium-glucose co-transporter-2 inhibitors (SGLT2is) for glycaemic control is increasing in individuals with type 2 diabetes (T2D) for their additional benefits on heart failure and chronic kidney disease. However, SGLT2is generally reduce body weight, which might promote sarcopenia in older individuals. We evaluated the effects of the SGLT2i empagliflozin on muscle mass and strength in addition to glucose control in elderly adults with T2D. MATERIALS AND METHODS Individuals with T2D aged ≥65 years with body mass index ≥22 kg/m2 and glycated haemoglobin (HbA1c) 7.0%-10.0% were randomized 1:1 to once-daily empagliflozin 10 mg or placebo for 52 weeks. The primary endpoint was change from baseline in HbA1c at week 52. Secondary endpoints included changes from baseline in muscle mass and strength. RESULTS Of the 129 individuals randomized, 72.4% were men, mean age 74.1 years, body mass index 25.6 kg/m2 and HbA1c 7.6%. The placebo-adjusted mean change from baseline in HbA1c at week 52 with empagliflozin was -0.57% [95% confidence interval (CI) -0.78, -0.36]. Change in body weight was -3.26 kg and -0.90 kg with empagliflozin and placebo, respectively (placebo-adjusted difference: -2.37 kg; 95% CI -3.07, -1.68). Placebo-adjusted change in muscle mass was -0.61 kg (95% CI -1.61, 0.39), fat mass -1.84 kg (95% CI -2.65, -1.04) and grip strength -0.3 kg (95% CI -1.1, 0.5). CONCLUSIONS Empagliflozin improved glucose control and reduced body weight without compromising muscle mass or strength in elderly adults with T2D in this trial.
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Affiliation(s)
- Daisuke Yabe
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kyoto, Japan
- Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
- Center for One Medicine Innovative Translational Research, Gifu University, Gifu, Japan
| | - Kosuke Shiki
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Gosuke Homma
- Biostatistics & Data Science, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Thomas Meinicke
- Therapeutic Area Cardiovascular/Metabolism/Respiratory, Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Yuji Ogura
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Yutaka Seino
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kyoto, Japan
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
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Ito H, Inoue H, Izutsu T, Matsumoto S, Antoku S, Yamasaki T, Mori T, Togane M. Changes in the estimated glomerular filtration rate and predictors of the renal prognosis in Japanese patients with type 2 diabetes: A retrospective study during the 12 months after the initiation of tofogliflozin. PLoS One 2023; 18:e0292014. [PMID: 37733761 PMCID: PMC10513294 DOI: 10.1371/journal.pone.0292014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The changes in the estimated glomerular filtration rate (eGFR) and predictors of the renal prognosis were retrospectively assessed over the 12 months after the initiation of tofogliflozin, which has the shortest half-life among sodium-glucose cotransporter 2 (SGLT2) inhibitors, in Japanese patients with type 2 diabetes and renal impairment. METHODS In total, 158 patients treated with tofogliflozin between 2019 and 2021 were studied as the safety analysis set. One hundred and thirty subjects whose medication was continued over 12 months were investigated as the full analysis set. The subjects were divided into two groups based on the eGFR: normal- (eGFR ≥60 mL/min/1.73 m2, n = 87) and low- (eGFR <60 mL/min/1.73 m2, n = 43) eGFR groups. RESULTS The body weight, blood pressure, urinary protein excretion, and serum uric acid concentration decreased from baseline in both eGFR groups while the hemoglobin level increased. The eGFR did not significantly differ over time, except for the initial dip (-4.3±9.6 mL/min/1.73 m2 in the normal-eGFR group and -1.5±5.3 mL/min/1.73 m2 in the low-eGFR group). The change in the eGFR at 12 months after the initiation of tofogliflozin was -1.9±9.0 mL/min/1.73 m2 and 0.2±6.0 mL/min/1.73 m2 in the normal- and low-eGFR group, respectively. In the normal-eGFR group, the change in the eGFR showed a significant negative correlation with the HbA1c and eGFR at baseline, according to a multiple regression analysis. In the low-eGFR group, the change in the eGFR showed a significant negative correlation with urate-lowering agent use. The frequencies of adverse events specific for SGLT2 inhibitors were not significantly different between the normal- and low-eGFR groups. CONCLUSIONS Tofogliflozin may preserve renal function in the medium term in patients with type 2 diabetes and kidney impairment without an increase in specific adverse events.
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Affiliation(s)
- Hiroyuki Ito
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Hideyuki Inoue
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Takuma Izutsu
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Suzuko Matsumoto
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Shinichi Antoku
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Tomoko Yamasaki
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Toshiko Mori
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
| | - Michiko Togane
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Edogawa-Ku, Tokyo, Japan
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AKHANLI P, HEPŞEN S, ARSLAN İE, DÜĞER H, BOSTAN H, KIZILGÜL M, UÇAN B, ÇAKAL E. Impact of 24-week dapagliflozin treatment on body weight, body composition, and cardiac risk indicators of patients with type-2 diabetes mellitus. Turk J Med Sci 2023; 53:1178-1184. [PMID: 38813008 PMCID: PMC10763806 DOI: 10.55730/1300-0144.5683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/26/2023] [Accepted: 08/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim To reveal the impacts of dapagliflozin, a sodium glucose transporter-2 inhibitor (SGLT-2i), on body weight and body composition, cardiovascular risk indices, and carotid intima-media thickness (CIMT). Materials and methods The data of patients with type-2 diabetes mellitus (T2DM) who applied to Department of Endocrinology and Metabolic Disorders between September 2019 and 2020, and had started dapagliflozin treatment along with their current medications were recorded retrospectively. Body weights, body compositions measured through bioelectrical impedance, and CIMT with T2DM receiving SGLT-2i treatment and medication were measured at weeks 1, 12, and 24 of 42. The visceral adiposity index (VAI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP) were used to determine the lipid measurements and anthropometric values. Results The mean change in the total body weight and total fat mass was -2.96 and -1.97 kg, respectively (p < 0.001). There was a reduction in total fat mass of 1.23 kg (from 31.4 to 29.3 kg, p < 0.001) and in body fat percentage of 2.5% (from 35.8% to 34.4%, p < 0.001) in the first 12 weeks. A mild increase was observed in both the total fat mass and body fat percentage between weeks 12 and 24, which was not statistically significant (p = 0.783 and p = 0.925, respectively), whereas there was a statistically significant reduction in high-sensitive C-reactive protein (hsCRP), AIP, and CIMT values (p = 0.006, p = 0.035, and p = 0.007, respectively). No changes were observed in the VAI and LAP values (p = 0.985 and p = 0.636, respectively). Conclusion It was observed that dapagliflozin not only contributes to weight and fat loss but also has positive impacts on cardiovascular and atherosclerotic indicators.
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Affiliation(s)
- Pınar AKHANLI
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Sema HEPŞEN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - İsmail Emre ARSLAN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Hakan DÜĞER
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Hayri BOSTAN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Muhammed KIZILGÜL
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Bekir UÇAN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
| | - Erman ÇAKAL
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkiye
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Yang X, Wang L, Zhang L, Zhai X, Sheng X, Quan H, Lin H. Exercise mitigates Dapagliflozin-induced skeletal muscle atrophy in STZ-induced diabetic rats. Diabetol Metab Syndr 2023; 15:154. [PMID: 37438792 PMCID: PMC10337193 DOI: 10.1186/s13098-023-01130-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are commonly used in the management of type 2 diabetes mellitus (T2DM) and have been found to worsen the reduction of skeletal muscle mass in individuals with T2DM. This study aims to examine the potential of exercise in mitigating the skeletal muscle atrophy induced by SGLT2i treatment. METHODS A rat model of T2DM (40 male Sprague-Dawley rats; T2DM induced by a combination of high-fat diet and streptozotocin) was used to examine the effects of six-week treatment with Dapagliflozin (DAPA, SGLT2i) in combination with either aerobic exercise (AE) or resistance training (RT) on skeletal muscle. T2DM-eligible rats were randomized into the T2DM control group (CON, n = 6), DAPA treatment group (DAPA, n = 6), DAPA combined with aerobic exercise intervention group (DAPA + AE, n = 6), and DAPA combined with resistance training intervention group (DAPA + RT, n = 6). To assess the morphological changes in skeletal muscle, myosin ATPase and HE staining were performed. mRNA expression levels of Atrogin-1, MuRF1, and Myostatin were determined using quantitative PCR. Furthermore, protein expression levels of AKT, p70S6K, mTOR, FoXO1/3A, NF-κB, and MuRF1 were examined through western blotting. RESULTS Both the administration of DAPA alone and the combined exercise intervention with DAPA resulted in significant reductions in blood glucose levels and body weight in rats. However, DAPA alone administration led to a decrease in skeletal muscle mass, whereas RT significantly increased skeletal muscle mass and muscle fiber cross-sectional area. The DAPA + RT group exhibited notable increases in both total protein levels and phosphorylation levels of AKT and p70S6K in skeletal muscle. Moreover, the DAPA, DAPA + AE, and DAPA + RT groups demonstrated downregulation of protein expression (FoXO1/3A) and mRNA levels (Atrogin-1, MuRF1, and Myostatin) associated with muscle atrophy. CONCLUSIONS Our findings provide support for the notion that dapagliflozin may induce skeletal muscle atrophy through mechanisms unrelated to protein metabolism impairment in skeletal muscle, as it does not hinder protein metabolic pathways while reduces muscle atrophy-related genes. Additionally, our observations reveal that RT proves more effective than AE in enhancing skeletal muscle mass and muscle fiber cross-sectional area in rats with T2DM by stimulating protein anabolism within the skeletal muscle.
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Affiliation(s)
- Xudong Yang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Lifeng Wang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Liangzhi Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Xia Zhai
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, Jinhua, Zhejiang, China
| | - Xiusheng Sheng
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, Jinhua, Zhejiang, China
| | - Helong Quan
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua, Zhejiang, China.
- School of Sports Science and Physical Education, Research Center of Sports and Health Science, Northeast Normal University, 5268 Renmin Street, Changchun, Jilin, 130024, China.
| | - Hengjun Lin
- Department of Colorectal anal surgery, Jinhua people's hospital, 267 Danxi East Road, Jinhua, Zhejiang, 321007, China.
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Nomura S, Shouzu A, Taniura T, Okuda Y, Omoto S, Suzuki M, Ito T, Toyoda N. Effects of Tofogliflozin and Anagliptin Alone or in Combination on Glucose Metabolism and Atherosclerosis-Related Markers in Patients with Type 2 Diabetes Mellitus. Clin Pharmacol 2023; 15:41-55. [PMID: 37255963 PMCID: PMC10226515 DOI: 10.2147/cpaa.s409786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose In people with type 2 diabetes mellitus (T2DM), both glucose metabolism abnormalities and atherosclerosis risk are significant concerns. This study aims to investigate the effects of the sodium-glucose cotransporter 2 inhibitor tofogliflozin (TOFO) and the dipeptidyl peptidase-4 inhibitor anagliptin (ANA) on markers of glucose metabolism and atherosclerosis when administered individually or in combination. Methods Fifty T2DM patients were divided into two groups (receiving either TOFO or ANA monotherapy) and observed for 12 weeks (observation points: 0 and 12 weeks). The TOFO and ANA groups were then further treated with ANA and TOFO, respectively, and the patients were observed for an additional 36 weeks (observation points: 24 and 48 weeks). Therapeutic effects and various biomarkers were compared between the two groups at the observation points. Results Combination therapy led to significant improvements in HbA1c levels and atherosclerosis markers. Additionally, the TOFO pretreatment group exhibited significant reductions in sLOX-1 and IL-6 levels. Conclusion The increase in sLOX-1 and IL-6 levels, which indicates the response of scavenger receptors to oxidized low-density lipoproteins in people with T2DM, is mitigated following TOFO and ANA combination therapy. TOFO alone or in combination with ANA may be beneficial for preventing atherosclerosis development in people with T2DM, in addition to its effect on improving HbA1c levels.
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Affiliation(s)
- Shosaku Nomura
- Center of Thrombosis and Hemostasis, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Akira Shouzu
- Division of Diabetes, Saiseikai Izuo Hospital, Osaka, Japan
| | | | - Yoshinori Okuda
- Division of Internal Medicine, Meisai Kinen Hospital, Osaka, Japan
| | - Seitaro Omoto
- Division of Internal Medicine, Yukeikai Hospital, Neyagawa, Japan
| | - Masahiko Suzuki
- Division of Internal Medicine, Katano Hospital, Katano, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Nagaoki Toyoda
- Second Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
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Comparison of Sodium-Glucose Cotransporter-2 Inhibitors and Thiazolidinediones for Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Clin Res Hepatol Gastroenterol 2023; 47:102111. [PMID: 36931466 DOI: 10.1016/j.clinre.2023.102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The pharmacologic treatment of non-alcoholic fatty liver disease (NAFLD) remains unclear. METHODS Two reviewers searched PubMed, SCOPUS, Cochrane Central and clinicaltrials.gov for randomized controlled trials (RCTs) of patients with NAFLD with or without type 2 diabetes mellitus (T2DM) receiving TZDs vs SGLT2 inhibitors. The primary outcomes were change in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) and improvement in steatosis and fibrosis. The secondary outcomes were changes in lipid profile, body weight and glycated hemoglobin (HbA1c). Random effects models with continuous outcomes as weighted mean differences (WMD) with 95% confidence intervals (CI) were used. RESULTS Five studies (n= 311 NAFLD patients) were included. Patients treated with SGLT2 inhibitors (n= 156) showed significant decrease in visceral fat area (VFA; WMD 23.45, p<0.00001) and body weight (WMD 4.22, p<0.00001) as compared to those treated with TZDs (n= 155). Patients from both groups showed improvement in AST (WMD 1.21, p= 0.40), ALT (WMD -0.46, p= 0.81), GGT (WMD -0.47, p= 0.84), hepatic fibrosis (WMD 0.11, p= 0.52), LDL (WMD 2.19, p= 0.35), HbA1c (WMD -0.16%, p= 0.20), HOMA-IR (WMD: -0.04, p= 0.91) and FPG (WMD -7.37, p= 0.28) which was equivalent and non-significant. CONCLUSION The improvement in liver enzymes, steatosis and fibrosis caused by SGLT2 inhibitors and TZDs was similar. SGLT2 inhibitors, however, resulted in a significant decrease in VFA and body weight. As weight loss is found to have a positive effect on the resolution of steatosis and fibrosis in NAFLD patients, SGLT2 inhibitors may have the potential to be considered for long-term management, however, further research needs to be conducted to determine the utility of SGLT2 inhibitor class of antidiabetic drugs for effectively treating NAFLD.
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Kurata Y, Nangaku M. Dapagliflozin for the treatment of chronic kidney disease. Expert Rev Endocrinol Metab 2022; 17:275-291. [PMID: 35822873 DOI: 10.1080/17446651.2022.2099373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Sodium-dependent glucose cotransporter 2 (SGLT2) is a glucose transporter expressed on the proximal tubular cells, where it reabsorbs glucose from the glomerular filtrate. SGLT2 inhibitors (SGLT2is), initially developed as an antidiabetic drug, have recently attracted considerable attention because they have cardiorenal protective effects. Among SGLT2is, dapagliflozin was the first to demonstrate the renoprotective effect in patients with and without diabetes and has been approved for chronic kidney disease (CKD) treatment. AREAS COVERED This review covers the pharmacological characteristics and the clinical efficacy and safety profiles of dapagliflozin, including comparison with other SGLT2is and risk modification strategies. EXPERT OPINION In DAPA-CKD, dapagliflozin reduced the primary outcome (≥50% estimated glomerular filtration rate [eGFR] decline, end-stage kidney disease [ESKD], or renal or cardiovascular [CV] death) by 39% in CKD patients. This beneficial effect was consistent across prespecified subgroups, including those based on the presence of diabetes. Dapagliflozin also decreased the CV composite outcome and all-cause death by 29% and 31%, respectively. Although an increased risk of adverse events such as ketoacidosis and volume depletion has been reported, the robust renal and CV benefits of dapagliflozin are expected to outweigh potential risks. SGLT2is, including dapagliflozin, will constitute the mainstay of CKD treatment.
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Affiliation(s)
- Yu Kurata
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Japan
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Horibe K, Morino K, Miyazawa I, Tanaka-Mizuno S, Kondo K, Sato D, Ohashi N, Ida S, Yanagimachi T, Yoshimura M, Itoh R, Murata K, Miura K, Arima H, Fujita Y, Ugi S, Maegawa H. Metabolic changes induced by dapagliflozin, an SGLT2 inhibitor, in Japanese patients with type 2 diabetes treated by oral anti-diabetic agents: A randomized, clinical trial. Diabetes Res Clin Pract 2022; 186:109781. [PMID: 35181350 DOI: 10.1016/j.diabres.2022.109781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/03/2022]
Abstract
AIM We aimed to determine whether SGLT2 inhibitor dapagliflozin treatment affects body composition and amino acid (AA) metabolism. METHODS Fifty-two overweight patients treated by oral antidiabetic agents were randomly assigned to dapagliflozin (Dapa) or a standard treatment (Con) and followed for 24 weeks. The primary outcome was the change in body mass (BM) between baseline and week 24. Body composition, intrahepatic triglyceride (IHTG) content, and plasma AA concentrations were examined as secondary outcomes. RESULTS The change in BM was significantly larger in the Dapa than in the Con group, with a difference in the mean change of -1.72 kg (95 %CI: -2.85, -0.59; P = 0.004) between the groups. Total fat mass was reduced by dapagliflozin treatment, but fat-free mass was maintained. IHTG content was significantly reduced in the Dapa than in the Con (P = 0.033). Changes in AAs showed small differences between the groups, but only serine concentrations were significantly reduced in the Dapa. Intra-group analysis showed that positive associations were observed between changes in branched chain AA concentrations and body composition only in the Dapa. CONCLUSIONS Dapagliflozin treatment causes a reduction in BM mainly by reducing fat mass. AA metabolism shows subtle changes with dapagliflozin treatment.
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Affiliation(s)
- Kayo Horibe
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Institutional Research Office, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
| | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Medical Statistics, Shiga University of Medical Science, Shiga 520-2192, Japan; Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto 606-8501, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Daisuke Sato
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Natsuko Ohashi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Department of Stem Cell Biology and Regenerative Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shogo Ida
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Tsuyoshi Yanagimachi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masahiro Yoshimura
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Ryuta Itoh
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Rakusai New Town Hospital, Kyoto 610-1142, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka 814-0133, Japan
| | - Yukihiro Fujita
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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12
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Sato D, Nakamura T, Amarume J, Yano M, Umehara Y, Nishina A, Tsutsumi K, Feng Z, Kusunoki M. Effects of dapagliflozin on adipose and liver fatty acid composition and mRNA expression involved in lipid metabolism in high-fat-fed rats. Endocr Metab Immune Disord Drug Targets 2022; 22:944-953. [PMID: 35255800 DOI: 10.2174/1871530322666220307153618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND SGLT2 inhibitor enhances not only glucose excretion but also fatty acid utilization. Those facts suggest that SGLT2 inhibitor affects fat accumulation and lipid storage. OBJECTIVE In the present study, we evaluated the effects of dapagliflozin on fatty acid composition and gene expression involved in fatty acid metabolism in rat adipose and liver tissues. METHODS We administered 1 mg/kg/day dapagliflozin for 7 weeks to male high-fat-fed rats (DAPA group), and then weights and 22 fatty acid contents in the epididymal (EPI), mesenteric (MES), retroperitoneal (RET) and subcutaneous (SUB) adipose tissues, and the liver were compared with vehicle-administered control group. RESULTS In the EPI, RET, and SUB in the DAPA group, contents of several fatty acids were lower (P<0.05) than those in the control group while no significant difference was detected in tissue weight. In the MES, not only tissue weight but also wide variety of fatty acid contents including saturated, monounsaturated, and polyunsaturated fatty acids were lower (P<0.05). As for the liver tissue, no significant difference was observed in fatty acid contents between the groups. mRNA expression of Srebp1c in EPI was significantly higher (P<0.05) in the DAPA group than in the control group, while Scd1 expression in the liver was lower (P<0.01). CONCLUSION These results suggest that dapagliflozin might suppress lipid accumulation especially in the MES, and could reduce contents of fatty acids not in the liver but in adipose tissues in high-fat-fed rats. In addition, dapagliflozin could influence mRNA expression involved in lipogenesis in the EPI and liver.
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Affiliation(s)
- Daisuke Sato
- Department of Biochemical Engineering, Graduate School of Science and Engineering, Yamagata University (4-3-16 Johnan, Yonezawa 992-8510, Japan)
| | - Takao Nakamura
- Department of Biomedical Information Engineering, Graduate School of Medical Science, Yamagata University (2-2-2 Iida-nishi, Yamagata 990-9585, Japan)
| | - Jota Amarume
- Department of Bio-Systems Engineering, Graduate School of Science and Engineering, Yamagata University (4-3-16 Johnan, Yonezawa 992-8510, Japan)
| | - Mizuna Yano
- Department of Bio-Systems Engineering, Graduate School of Science and Engineering, Yamagata University (4-3-16 Johnan, Yonezawa 992-8510, Japan)
| | - Yuta Umehara
- Department of Bio-Systems Engineering, Graduate School of Science and Engineering, Yamagata University (4-3-16 Johnan, Yonezawa 992-8510, Japan)
| | - Atsuyoshi Nishina
- Department of Materials and Applied Chemistry, College of Science and Technology, Nihon University (1-8-14 Kandasurugadai, Chiyoda-ku, 101-8308, Japan)
| | - Kazuhiko Tsutsumi
- Okinaka Memorial Institute for Medical Research (2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan)
| | - Zhonggang Feng
- Department of Bio-Systems Engineering, Graduate School of Science and Engineering, Yamagata University (4-3-16 Johnan, Yonezawa 992-8510, Japan)
| | - Masataka Kusunoki
- Research Center of Health, Physical Fitness and Sports, Nagoya University (Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan)
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13
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Ma XY, Chen FQ. Effects of anti-diabetic drugs on sarcopenia: Best treatment options for elderly patients with type 2 diabetes mellitus and sarcopenia. World J Clin Cases 2021; 9:10064-10074. [PMID: 34904076 PMCID: PMC8638038 DOI: 10.12998/wjcc.v9.i33.10064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/22/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
Human life expectancy increases as society becomes more developed. This increased life expectancy poses challenges associated with the rapid aging of the population. Sarcopenia, an age-related disease, has become a worldwide health issue. Patients with sarcopenia experience decreases in muscle mass and function, becoming frail and eventually bedridden. Type 2 diabetes mellitus (T2DM) is also a major health issue; the incidence of T2DM increases with aging. T2DM is associated with reduced muscle strength and poor muscle quality and may contribute to acceleration of the aging process, augmenting age-related sarcopenia. Recent studies indicate that elderly patients with diabetes are at an increased risk for sarcopenia. Therefore, these older diabetic patients with sarcopenia need specific anti-diabetic therapies targeting not only glycemic control but also sarcopenia, with the goal of preventing sarcopenia in pre-sarcopenic patients. Presently, various types of hypoglycemic drugs are available, but which hypoglycemic drugs are better suited for geriatric T2DM patients with sarcopenia remains undetermined. In this review, we discuss the association between diabetes and sarcopenia in geriatric patients, and how anti-diabetic drugs may influence sarcopenia outcomes. This review will guide clinical workers in the selection of drugs best suited for this patient population.
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Affiliation(s)
- Xiao-Yu Ma
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fen-Qin Chen
- Department of Geriatrics, The First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
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14
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Higashikawa T, Ito T, Mizuno T, Ishigami K, Kuroki K, Maekawa N, Usuda D, Morita T, Hamada K, Takagi S, Takeshima K, Yamada S, Sangen R, Izumida T, Mori H, Kiyosawa J, Saito A, Iguchi M, Nakahashi T, Kasamaki Y, Fukuda A, Kanda T, Okuro M. Effects of tofogliflozin on adrenocorticotropic hormone, renin and aldosterone, and cortisol levels in elderly patients with diabetes mellitus: A retrospective study of a patient cohort. Medicine (Baltimore) 2021; 100:e27638. [PMID: 34766565 PMCID: PMC8589243 DOI: 10.1097/md.0000000000027638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/09/2021] [Indexed: 02/07/2023] Open
Abstract
Adrenocorticotropic hormone (ACTH) and cortisol reportedly play a role in glycemic control in patients with type 2 diabetes mellitus (T2DM); however, the underlying mechanism remains controversial. We retrospectively investigated the effect of tofogliflozin on serum ACTH and cortisol levels in elderly patients with T2DM.Patients received 20 mg tofogliflozin daily for 3 months. Serum ACTH and cortisol levels were measured at baseline, as well as after 1 month and 3 months of tofogliflozin therapy.Serum ACTH levels were significantly reduced 3 months after tofogliflozin treatment (P < .01). Additionally, serum cortisol levels were reduced 3 months after tofogliflozin treatment, demonstrating borderline significance (P = .05). The higher body mass index (BMI; ≥25 kg/m2) group showed higher ACTH and cortisol levels than the lower BMI (<25 kg/m2) group, with borderline significance (P = .05). Renin levels were significantly increased 1 month after treatment (P < .05), maintaining serum aldosterone levels in parallel with the extracellular fluid.Our findings suggested that tofogliflozin decreased both serum ACTH and cortisol levels, with higher levels observed in the high BMI group. Tofogliflozin increased serum renin levels while maintaining serum aldosterone and extracellular fluid levels. Collectively, tofogliflozin could affect the hypothalamic-pituitary-adrenal pathway in patients with T2DM, especially in the low BMI group.
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Affiliation(s)
- Toshihiro Higashikawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Tomohiko Ito
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Takurou Mizuno
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Keiichirou Ishigami
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Kengo Kuroki
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Naoto Maekawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Daisuke Usuda
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Susumu Takagi
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Kento Takeshima
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Shinya Yamada
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Ryusho Sangen
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Toshihide Izumida
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Hideyuki Mori
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Jun Kiyosawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Atsushi Saito
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Masaharu Iguchi
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Takeshi Nakahashi
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Yuji Kasamaki
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Akihiro Fukuda
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Tsugiyasu Kanda
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
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15
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Hoshika Y, Kubota Y, Mozawa K, Tara S, Tokita Y, Yodogawa K, Iwasaki YK, Yamamoto T, Takano H, Tsukada Y, Asai K, Miyamoto M, Miyauchi Y, Kodani E, Maruyama M, Tanabe J, Shimizu W. Effect of Empagliflozin Versus Placebo on Body Fluid Balance in Patients With Acute Myocardial Infarction and Type 2 Diabetes Mellitus: Subgroup Analysis of the EMBODY Trial. J Card Fail 2021; 28:56-64. [PMID: 34425223 DOI: 10.1016/j.cardfail.2021.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The development of heart failure is associated with fluid balance, including that of extracellular water (ECW) and intracellular water (ICW). This study determined whether sodium-glucose cotransporter 2 inhibitors affect fluid balance and improve heart failure in patients after acute myocardial infarction. METHODS AND RESULTS EMBODY was a prospective, randomized, double-blinded, placebo-controlled trial of Japanese patients with acute myocardial infarction and type 2 diabetes. Overall, 55 patients who underwent bioelectrical impedance analysis were randomized to receive once daily 10 mg empagliflozin or placebo 2 weeks after acute myocardial infarction onset. We investigated the time course of body fluid balance measured using the bioelectrical impedance analysis device, InBody. The primary end points were changes in body fluid balance from weeks 0 to 24. Changes between baseline and week 24 in the empagliflozin and placebo groups were -0.21 L (P = .127) and +0.40 L (P = .001) in ECW (P = .001) and -0.23 L (P = .264) and +0.74 L (P < .001) in ICW (P < .001), respectively. In a stratified analysis, the rise in ECW and ICW was significantly attenuated in the empagliflozin group in contrast to the placebo group in participants with a body mass index of 25 or higher but not in those with a body mass index of less than 25. CONCLUSIONS Early sodium-glucose cotransporter 2 inhibitor administration may attenuate changes in ECW and ICW.
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Affiliation(s)
- Yu Hoshika
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Kosuke Mozawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeshi Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yayoi Tsukada
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Masaaki Miyamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokuso, Hospital, Chiba, Japan
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama, Hospital, Tokyo, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan
| | - Jun Tanabe
- Department of Cardiovascular Medicine, Shizuoka Medical Center, Shizuoka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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16
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Estrada AK, Delgado-Maldonado T, Lara-Ramírez EE, Martínez-Vázquez AV, Ortiz-Lopez E, Paz-González AD, Bandyopadhyay D, Rivera G. Recent Advances in the Development of Type 2 Sodium-Glucose Cotransporter Inhibitors for the Treatment of Type 2 Diabetes Mellitus. Mini Rev Med Chem 2021; 22:586-599. [PMID: 34353256 DOI: 10.2174/1389557521666210805112416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is one of the most serious and prevalent diseases worldwide. In the last decade, type 2 sodium-glucose cotransporter inhibitors (iSGLT2) were approved as alternative drugs for the pharmacological treatment of T2DM. The anti-hyperglycemic mechanism of action of these drugs involves glycosuria. In addition, SGLT2 inhibitors cause beneficial effects such as weight loss, a decrease in blood pressure, and others. OBJECTIVE This review aimed to describe the origin of SGLT2 inhibitors and analyze their recent development in preclinical and clinical trials. RESULTS In 2013, the FDA approved SGLT2 inhibitors as a new alternative for the treatment of T2DM. These drugs have shown good tolerance with few adverse effects in clinical trials. Additionally, new potential anti-T2DM agents based on iSGLT2 (O-, C-, and N-glucosides) have exhibited a favorable profile in preclinical evaluations, making them candidates for advanced clinical trials. CONCLUSION The clinical results of SGLT2 inhibitors show the importance of this drug class as new anti-T2DM agents with a potential dual effect. Additionally, the preclinical results of SGLT2 inhibitors favor the design and development of more selective new agents. However, several adverse effects could be a potential risk for patients.
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Affiliation(s)
- Ana Karen Estrada
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Timoteo Delgado-Maldonado
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Edgar E Lara-Ramírez
- Unidad de Investigación Biomédica de Zacatecas, Instituto Mexicano del Seguro Social (IMSS), 98000 Zacatecas. Mexico
| | - Ana Verónica Martínez-Vázquez
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Eyra Ortiz-Lopez
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | - Alma D Paz-González
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
| | | | - Gildardo Rivera
- Laboratorio de Biotecnología Farmacéutica, Centro de Biotecnología Genómica, Instituto Politécnico Nacional, 88710 Reynosa. Mexico
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Yabe D, Shiki K, Suzaki K, Meinicke T, Kotobuki Y, Nishida K, Clark D, Yasui A, Seino Y. Rationale and design of the EMPA-ELDERLY trial: a randomised, double-blind, placebo-controlled, 52-week clinical trial of the efficacy and safety of the sodium-glucose cotransporter-2 inhibitor empagliflozin in elderly Japanese patients with type 2 diabetes. BMJ Open 2021; 11:e045844. [PMID: 33827843 PMCID: PMC8031078 DOI: 10.1136/bmjopen-2020-045844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Elderly people (≥65 years) with type 2 diabetes mellitus (T2DM) are becoming increasingly prevalent, notably in Japan. As cardiovascular (CV) risk increases with age and sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce CV risk, elderly patients with T2DM are increasingly likely to be prescribed these glucose-lowering drugs. There is controversy surrounding the effects of SGLT2 inhibitors on muscle mass, particularly in elderly patients for whom loss of muscle is especially undesirable; however, robust evidence on this important issue is lacking. Consequently, we have designed a clinical trial of the SGLT2 inhibitor empagliflozin in elderly Japanese patients with T2DM (Empagliflozin in Elderly T2DM Patients (EMPA-ELDERLY)) to assess its effects on body composition as well as glycaemic control. EMPA-ELDERLY will be the first randomised clinical trial of an SGLT2 inhibitor in elderly patients with T2DM to evaluate effects on skeletal muscle mass, muscle strength and physical performance concurrently. METHODS AND ANALYSIS EMPA-ELDERLY is a randomised, double-blind, placebo-controlled, parallel-group clinical trial to be conducted in Japan. Patients with T2DM aged ≥65 years are eligible if they are Japanese with a body mass index of ≥22 kg/m2 and glycated haemoglobin (HbA1c) levels from ≥7.0% to ≤10.0% from either diet and exercise alone or treatment with oral glucose-lowering drugs. Approximately 128 participants will be randomised 1:1 to once per day, oral, double-blind treatment with empagliflozin 10 mg or matching placebo for 52 weeks. The primary endpoint is the change in HbA1c level from baseline at week 52. Secondary endpoints include changes from baseline to 52 weeks in body composition, including muscle mass and body fat, measured by bioelectrical impedance analysis, as well as skeletal muscle index, grip strength and time in the five-time chair stand test. Other endpoints include changes in patient-reported outcomes (including quality of life), cognitive function and safety. ETHICS AND DISSEMINATION We will submit the trial results to conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04531462.
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Affiliation(s)
- Daisuke Yabe
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan
- Yutaka Seino Distinguished Centre for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
- Division of Molecular and Metabolic Medicine, Department of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kosuke Shiki
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Keiko Suzaki
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Thomas Meinicke
- Medicine Division, Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Yutaro Kotobuki
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Kenichiro Nishida
- Biostatistics and Data Science, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Douglas Clark
- Medicine Division, Boehringer Ingelheim UK Ltd, Bracknell, UK
| | - Atsutaka Yasui
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Yutaka Seino
- Yutaka Seino Distinguished Centre for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, Japan
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18
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Kaneto H, Obata A, Kimura T, Shimoda M, Kinoshita T, Matsuoka TA, Kaku K. Unexpected Pleiotropic Effects of SGLT2 Inhibitors: Pearls and Pitfalls of This Novel Antidiabetic Class. Int J Mol Sci 2021; 22:ijms22063062. [PMID: 33802741 PMCID: PMC8002535 DOI: 10.3390/ijms22063062] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors facilitate urine glucose excretion by reducing glucose reabsorption, leading to ameliorate glycemic control. While the main characteristics of type 2 diabetes mellitus are insufficient insulin secretion and insulin resistance, SGLT2 inhibitors have some favorable effects on pancreatic β-cell function and insulin sensitivity. SGLT2 inhibitors ameliorate fatty liver and reduce visceral fat mass. Furthermore, it has been noted that SGLT2 inhibitors have cardio-protective and renal protective effects in addition to their glucose-lowering effect. In addition, several kinds of SGLT2 inhibitors are used in patients with type 1 diabetes mellitus as an adjuvant therapy to insulin. Taken together, SGLT2 inhibitors have amazing multifaceted effects that are far beyond prediction like some emerging magical medicine. Thereby, SGLT2 inhibitors are very promising as relatively new anti-diabetic drugs and are being paid attention in various aspects. It is noted, however, that SGLT2 inhibitors have several side effects such as urinary tract infection or genital infection. In addition, we should bear in mind the possibility of diabetic ketoacidosis, especially when we use SGLT2 inhibitors in patients with poor insulin secretory capacity.
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Affiliation(s)
- Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; (A.O.); (T.K.); (M.S.); (T.K.)
- Correspondence:
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; (A.O.); (T.K.); (M.S.); (T.K.)
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; (A.O.); (T.K.); (M.S.); (T.K.)
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; (A.O.); (T.K.); (M.S.); (T.K.)
| | - Tomoe Kinoshita
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan; (A.O.); (T.K.); (M.S.); (T.K.)
| | - Taka-aki Matsuoka
- The First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8510, Japan;
| | - Kohei Kaku
- Department of General Internal Medicine 1, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan;
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19
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Chen L, Zhang M, Xiang S, Jiang X, Gu H, Sha Q, Qu M, Xu T. Association Between Thyroid Function and Body Composition in Type 2 Diabetes Mellitus (T2DM) Patients: Does Sex Have a Role? Med Sci Monit 2021; 27:e927440. [PMID: 33387440 PMCID: PMC7786834 DOI: 10.12659/msm.927440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The relationship between thyroid hormones and body anthropometric measures in type 2 diabetes mellitus (T2DM) patients with normal thyroid function is unclear. The purpose of this study was to evaluate the association between thyroid hormones and body composition in euthyroid T2DM patients in men and women. MATERIAL AND METHODS This was a cross-sectional study that included 561 euthyroid T2DM patients. Fasting venous blood was collected to test laboratory indexes. Bioelectric impedance analysis (BIA) was used to measure body composition. Propensity score matching (PSM) was used to enroll patients with similar baseline characteristics. The least absolute shrinkage and selection operator (LASSO) algorithm was used to establish a linear regression model of thyroid hormone and body composition. PSM was performed to match 159 men and 159 women. RESULTS The LASSO regression analysis suggested that thyroid-stimulating hormone (TSH) level was not correlated with body composition parameters in females. In females, free triiodothyronine (FT3) level was positively correlated with body mass index (BMI), fat-free mass index (FFMI), and skeletal muscle index (SMI), and was negatively correlated with extracellular water fraction (EWF). In males, FT3 level was positively correlated with waist circumference (WC) and SMI and negatively correlated with EWF. Free thyroxine (FT4) level in both women and men was positively correlated with body fat mass (BFM) and left lower-limb muscle mass (LLLMM). Moreover, in males, FT4 level was correlated with more body composition parameters. In euthyroid T2DM patients, FT3 level was positively correlated with SMI and negatively correlated with EWF, while FT4 level was positively correlated with BFM and LLLMM. CONCLUSIONS Thyroid function can affect body composition in euthyroid T2DM patients. Thyroid function is more likely to affect the fat and muscle distribution of males than females.
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Affiliation(s)
- Lu Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland).,Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Min Zhang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Shoukui Xiang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Xiaohong Jiang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Hongliu Gu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Qi Sha
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Meidi Qu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Ting Xu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
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20
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Tamura Y, Shimoji K, Ishikawa J, Tachibana A, Kodera R, Oba K, Toyoshima K, Chiba Y, Tokumaru AM, Araki A. Associations between sarcopenia and white matter alterations in older adults with diabetes mellitus: A diffusion tensor imaging study. J Diabetes Investig 2020; 12:633-640. [PMID: 32750745 PMCID: PMC8015831 DOI: 10.1111/jdi.13379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Aims/Introduction Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood. Materials and Methods The study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients’ diabetes status. Results We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto‐occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019‐defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation. Conclusions White matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes.
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Affiliation(s)
- Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya Tachibana
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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21
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Kayano H, Koba S, Hirano T, Matsui T, Fukuoka H, Tsuijita H, Tsukamoto S, Hayashi T, Toshida T, Watanabe N, Hamazaki Y, Geshi E, Murakami M, Aihara K, Kaneko K, Yamada H, Kobayashi Y, Shinke T. Dapagliflozin Influences Ventricular Hemodynamics and Exercise-Induced Pulmonary Hypertension in Type 2 Diabetes Patients - A Randomized Controlled Trial. Circ J 2020; 84:1807-1817. [PMID: 32921680 DOI: 10.1253/circj.cj-20-0341] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This prospective randomized multicenter open-label trial evaluated whether sodium-glucose cotransporter-2 inhibitor (SGLT2-i) improves left ventricular (LV) pump function and suppresses elevation of LV filling pressure (LVFP) and right ventricular systolic pressure (RVSP) during exercise in type 2 diabetes mellitus (T2DM) patients.Methods and Results:Based on HbA1c and LV ejection fraction, 78 patients with poorly controlled T2DM were randomly assigned to D-group (dapagliflozin 5 mg/day add-on) or C-group (conventional therapy add-on). Physical examination, home and office blood pressure examination, blood tests, and echocardiography at rest and during ergometer exercise were performed at baseline and at 1.5 and 6 months after treatment. The primary endpoint was defined as the change in RVSP (mmHg) between baseline and 6-month follow up. The secondary endpoints were changes in LVFP (ratio), stroke volume index (SVi; mL/m2), and cardiac index (CI; L/min/m2). Both RVSP and LVFP during exercise significantly decreased from baseline to 6 months after starting treatment in the D-group (P<0.001). No changes to either parameter was observed in the C-group. The SVi and CI did not improve in either group. Both home and office blood pressure significantly decreased in the D-group. Decreases in HbA1c were somewhat greater in the C-group. CONCLUSIONS Dapagliflozin significantly improved RVSP and LVFP during exercise in patients with T2DM and cardiovascular risk, which may contribute to favorable effects on heart failure.
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Affiliation(s)
- Hiroyuki Kayano
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Shinji Koba
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine
| | - Taiju Matsui
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Hiroto Fukuoka
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Hiroaki Tsuijita
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Shigeto Tsukamoto
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Toshiyuki Hayashi
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine
| | - Tsutomu Toshida
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Norikazu Watanabe
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Yuji Hamazaki
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Eiichi Geshi
- Department of Internal Medicine, Showa University School of Nursing and Rehabilitation Sciences
| | | | | | | | | | - Youichi Kobayashi
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Toshiro Shinke
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
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22
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Hallow KM, Boulton DW, Penland RC, Helmlinger G, Nieves EH, van Raalte DH, Heerspink HL, Greasley PJ. Renal Effects of Dapagliflozin in People with and without Diabetes with Moderate or Severe Renal Dysfunction: Prospective Modeling of an Ongoing Clinical Trial. J Pharmacol Exp Ther 2020; 375:76-91. [PMID: 32764153 DOI: 10.1124/jpet.120.000040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 12/25/2022] Open
Abstract
Sodium glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular events and onset and progression of renal disease by mechanisms that remain incompletely understood but may include clearance of interstitial congestion and reduced glomerular hydrostatic pressure. The ongoing DAPASALT mechanistic clinical study will evaluate natriuretic, diuretic, plasma/extracellular volume, and blood pressure responses to dapagliflozin in people with type 2 diabetes with normal or impaired renal function (D-PRF and D-IRF, respectively) and in normoglycemic individuals with renal impairment (N-IRF). In this study, a mathematical model of renal physiology, pathophysiology, and pharmacology was used to prospectively predict changes in sodium excretion, blood and interstitial fluid volume (IFV), blood pressure, glomerular filtration rate, and albuminuria in DAPASALT. After validating the model with previous diabetic nephropathy trials, virtual patients were matched to DAPASALT inclusion/exclusion criteria, and the DAPASALT protocol was simulated. Predicted changes in glycosuria, blood pressure, glomerular filtration rate, and albuminuria were consistent with other recent studies in similar populations. Predicted albuminuria reductions were 46% in D-PRF, 34.8% in D-IRF, and 14.2% in N-IRF. The model predicts a similarly large IFV reduction between D-PRF and D-IRF and less, but still substantial, IFV reduction in N-IRF, even though glycosuria is attenuated in groups with impaired renal function. When DAPASALT results become available, comparison with these simulations will provide a basis for evaluating how well we understand the cardiorenal mechanism(s) of SGLT2i. Meanwhile, these simulations link dapagliflozin's renal mechanisms to changes in IFV and renal biomarkers, suggesting that these benefits may extend to those with impaired renal function and individuals without diabetes. SIGNIFICANCE STATEMENT: Mechanisms of SGLT2 inhibitors' cardiorenal benefits remain incompletely understood. We used a mathematical model of renal physiology/pharmacology to prospectively predict responses to dapagliflozin in the ongoing DAPASALT study. Key predictions include similarly large interstitial fluid volume (IFV) reductions between subjects with normal and impaired renal function and less, but still substantial, IFV reduction in those without diabetes, even though glycosuria is attenuated in these groups. Comparing prospective simulations and study results will assess how well we understand the cardiorenal mechanism(s) of SGLT2 inhibitors.
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Affiliation(s)
- K Melissa Hallow
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - David W Boulton
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Robert C Penland
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Gabriel Helmlinger
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Emily H Nieves
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Daniël H van Raalte
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Hiddo L Heerspink
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
| | - Peter J Greasley
- Department of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia (K.M.W., E.N.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland (D.W.B.); Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Waltham, Massachusetts (R.C.P., G.H.); Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands (D.H.v.R.); Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands (H.L.H.); The George Institute for Global Health, Sydney, Australia (H.L.H.); and Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (P.J.G.)
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23
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Katakami N, Mita T, Yoshii H, Shiraiwa T, Yasuda T, Okada Y, Torimoto K, Umayahara Y, Kaneto H, Osonoi T, Yamamoto T, Kuribayashi N, Maeda K, Yokoyama H, Kosugi K, Ohtoshi K, Hayashi I, Sumitani S, Tsugawa M, Ryomoto K, Taki H, Nakamura T, Kawashima S, Sato Y, Watada H, Shimomura I. Tofogliflozin does not delay progression of carotid atherosclerosis in patients with type 2 diabetes: a prospective, randomized, open-label, parallel-group comparative study. Cardiovasc Diabetol 2020; 19:110. [PMID: 32646498 PMCID: PMC7350187 DOI: 10.1186/s12933-020-01079-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the preventive effects of tofogliflozin, a selective sodium-glucose cotransporter 2 (SGLT2) inhibitor, on atherosclerosis progression in type 2 diabetes (T2DM) patients without apparent cardiovascular disease (CVD) by monitoring carotid intima-media thickness (IMT). METHODS This prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group, comparative study included 340 subjects with T2DM and no history of apparent CVD recruited at 24 clinical units. Subjects were randomly allocated to either the tofogliflozin treatment group (n = 169) or conventional treatment group using drugs other than SGLT2 inhibitors (n = 171). Primary outcomes were changes in mean and maximum common carotid IMT measured by echography during a 104-week treatment period. RESULTS In a mixed-effects model for repeated measures, the mean IMT of the common carotid artery (mean-IMT-CCA), along with the right and left maximum IMT of the CCA (max-IMT-CCA), significantly declined in both the tofogliflozin (- 0.132 mm, SE 0.007; - 0.163 mm, SE 0.013; - 0.170 mm, SE 0.020, respectively) and the control group (- 0.140 mm, SE 0.006; - 0.190 mm, SE 0.012; - 0.190 mm, SE 0.020, respectively). Furthermore, the tofogliflozin and the conventional treatment group did not significantly differ in the progression of the mean-IMT-CCA (mean change (95% CI) 0.008 (- 0.009, 0.025) mm, P = 0.34), along with the right (mean change (95% CI) 0.027 (- 0.005, 0.059) mm, P = 0.10) and the left max-IMT-CCA (mean change (95% CI) 0.020 (- 0.030, 0.070), P = 0.43). Similar findings were obtained even after adjusting for traditional CV risk factors and/or administration of drugs at baseline. Relative to the control treatment effects, tofogliflozin significantly reduced the HbA1c, blood glucose level, body weight/body mass index, abdominal circumference, and systolic blood pressure, and significantly increased the HDL-C. The total and serious adverse events incidences did not significantly vary between the treatment groups. CONCLUSIONS/INTERPRETATION No IMT changes were observed between the tofogliflozin and the conventional treatment groups. However, tofogliflozin is a safe and effective treatment option for managing primary CVD risk factors in this population. Clinical Trial Registration UMIN000017607 ( https://www.umin.ac.jp/icdr/index.html ).
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Affiliation(s)
- Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tomoya Mita
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hidenori Yoshii
- Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo, 136-0075, Japan
| | - Toshihiko Shiraiwa
- Shiraiwa Medical Clinic, 4-10-24 Hozenji, Kashiwara City, Osaka, 582-0005, Japan
| | - Tetsuyuki Yasuda
- Department of Diabetes and Endocrinology, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan
| | - Yosuke Okada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Keiichi Torimoto
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yutaka Umayahara
- Department of Diabetes and Endocrinology, Osaka General Medical Center, 3-1-56, Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takeshi Osonoi
- Nakakinen Clinic, 745-5, Nakadai, Naka City, Ibaraki, 311-0113, Japan
| | - Tsunehiko Yamamoto
- Diabetes and Endocrinology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo, Japan
| | | | - Kazuhisa Maeda
- Kitasenri Maeda Clinic, 4-119 Furuedai, Suita, Osaka, 565-0874, Japan
| | - Hiroki Yokoyama
- Jiyugaoka Medical Clinic, West 6, South 6-4-3, Obihiro, Hokkaido, 080-0016, Japan
| | - Keisuke Kosugi
- Kosugi Medical Clinic, 3-9, Tamatsukurimoto-cho, Tennoji-ku, Osaka, 543-0014, Japan
| | - Kentaro Ohtoshi
- Otoshi Medical Clinic, 8-47, Kakudacho, Osaka Kita-ku, Osaka, 530-0017, Japan
| | - Isao Hayashi
- Hayashi Clinic, 3-9-23 Koshienguchi, Nishinomiya, Hyogo, 663-8113, Japan
| | - Satoru Sumitani
- Center for Diabetes and Endocrinology, Nippon Life Hospital, 2-1-54 Enokojima, Nishi-ku, Osaka, 550-0006, Japan
| | - Mamiko Tsugawa
- Department of Endocrinology and Metabolism, Ikeda Municipal Hospital, 3-1-18, Jonan, Ikeda, Osaka, 563-8510, Japan
| | - Kayoko Ryomoto
- Center for Diabetes Mellitus, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hideki Taki
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Tadashi Nakamura
- Department of Internal Medicine, Kawasaki Hospital, 3-3-1, Higashiyamacho, Kobe Hyogo-ku, Hyogo, 652-0042, Japan
| | - Satoshi Kawashima
- Kanda Naika Clinic, 5-21-3, Hannancho, Osaka Abeno-ku, Osaka, 545-0021, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 45 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirotaka Watada
- Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Utsunomiya K, Kakiuchi S, Senda M, Fujii S, Kurihara Y, Gunji R, Koshida R, Kameda H, Tamura M, Kaku K. Safety and effectiveness of tofogliflozin in Japanese patients with type 2 diabetes mellitus: Results of 24-month interim analysis of a long-term post-marketing study (J-STEP/LT). J Diabetes Investig 2020; 11:906-916. [PMID: 32034997 PMCID: PMC7378444 DOI: 10.1111/jdi.13233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION Tofogliflozin is a potent and highly selective sodium-glucose cotransporter 2 inhibitor, and is currently used to treat patients with type 2 diabetes mellitus. We designed a 3-year study of tofogliflozin in patients with type 2 diabetes mellitus to evaluate the safety and effectiveness in routine clinical practice. The 3- and 12-month interim analysis showed tofogliflozin was well-tolerated, safe and clinically effective. Here, we report the results of the 24-month interim analysis. MATERIALS AND METHODS This is a 3-year prospective, observational and multicenter post-marketing study (Japanese Study of Tofogliflozin with Type 2 Diabetes Mellitus Patients/Long Term). RESULTS Of the 6,897 patients enrolled, 6,712 and 6,461 patients were analyzed for the safety and effectiveness of tofogliflozin, respectively. During the 24-month observation period, the incidence rates of adverse drug reactions (ADRs) and serious adverse drug reactions were 11.25 and 1.21%, respectively. As to adverse drug reactions of special interest, the incidence rates of hypoglycemia, polyuria/pollakiuria, volume depletion-related events, urinary tract infections and genital infection were 0.83, 1.28, 1.46, 1.18 and 1.62%, respectively. Renal disorders, and cardiovascular and cerebrovascular disorders occurred in 0.63 and 0.76% of the patients, respectively. Glycated hemoglobin A1c and bodyweight decreased significantly by -0.70% (P < 0.0001) and -2.95 kg (P < 0.0001), respectively, from baseline to week 104 (last observation carried forward). CONCLUSIONS Significant safety concerns have not been observed, and clinical benefit including a long-term reduction in glycated hemoglobin A1c over a 104-week (24 months) observation period with weight loss was suggested in this 24-month interim analysis of the 3-year Japanese Study of Tofogliflozin with Type 2 Diabetes Mellitus Patients/Long Term in routine clinical practice.
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Affiliation(s)
- Kazunori Utsunomiya
- Center for Preventive MedicineThe Jikei University School of MedicineTokyoJapan
| | - Seigo Kakiuchi
- Post Marketing Surveillance DepartmentKowa Company, Ltd.TokyoJapan
| | | | - Shoko Fujii
- Post Marketing Surveillance DepartmentKowa Company, Ltd.TokyoJapan
| | - Yuji Kurihara
- Post Marketing Surveillance DepartmentKowa Company, Ltd.TokyoJapan
| | - Ryoji Gunji
- Post Marketing Surveillance DepartmentKowa Company, Ltd.TokyoJapan
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Sodium-Glucose Cotransporter 2 Inhibitors and Kidney Outcomes: True Renoprotection, Loss of Muscle Mass or Both? J Clin Med 2020; 9:jcm9051603. [PMID: 32466262 PMCID: PMC7291210 DOI: 10.3390/jcm9051603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
Inhibitors of sodium-glucose cotransporter 2 (SGLT2) have emerged as practice-changing treatments for patients with type 2 diabetes, reducing both the risk of cardiovascular events and kidney events. However, regarding the latter, caution is warranted, as these kidney endpoints are defined using glomerular filtration rate estimations based on creatinine, the non-enzymatic product of creatine residing in muscles. Creatinine-based estimations of the glomerular filtration rate are only valid if the treatment has no effect on changes in muscle mass over time. Yet, circumstantial evidence suggests that treatment with SGLT2 inhibitors does result in a loss of muscle mass, rendering serum creatinine-based kidney endpoints invalid. Currently, it cannot be excluded that the described renoprotective effect of SGLT2 inhibitors is in part or in whole the consequence of a loss of muscle mass. Post-hoc analyses of existing trials or new trials based on kidney function markers independent of muscle mass can provide more definitive answers on the proposed renoprotective effects of SGLT2 inhibitors.
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26
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Fushimi Y, Obata A, Sanada J, Iwamoto Y, Mashiko A, Horiya M, Mizoguchi-Tomita A, Nishioka M, Kan Y, Kinoshita T, Okauchi S, Hirukawa H, Kohara K, Tatsumi F, Shimoda M, Nakanishi S, Mune T, Kaku K, Kaneto H. Effect of Combination Therapy of Canagliflozin Added to Teneligliptin Monotherapy in Japanese Subjects with Type 2 Diabetes Mellitus: A Retrospective Study. J Diabetes Res 2020; 2020:4861681. [PMID: 32337293 PMCID: PMC7154962 DOI: 10.1155/2020/4861681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/10/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022] Open
Abstract
Recently, dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors have been very often used in subjects with type 2 diabetes mellitus (T2DM). In addition, combination drugs of both inhibitors have attracted much attention in aspects of its cost-effectiveness and improvement of patients' adherence. However, it is still poorly understood which factors are related to the efficacy of SGLT2 inhibitors as add-on therapy to DPP-4 inhibitors. Therefore, we aimed to elucidate in which type of individuals and/or under which conditions canagliflozin as add-on therapy to teneligliptin could exert more beneficial effects on glycemic control and/or renal protection. We retrospectively analyzed 56 Japanese subjects with T2DM in the real-world clinical practice. Three months after starting the combination therapy, the change of HbA1c (ΔHbA1c) was strongly related to HbA1c levels at baseline. As expected, serum glucagon level was increased after starting the combination therapy. Interestingly, however, the change of glucagon levels (Δglucagon) was not related to HbA1c levels at baseline, ΔHbA1c, and other parameters, which indicated that the increase of glucagon did not clinically affect the effectiveness of combination therapy. In addition, the change of urinary albumin excretion (ΔUAE) was negatively correlated with systolic blood pressure and HbA1c levels at baseline and positively correlated with the change of systolic blood pressure (ΔsBP) in univariate analysis. Furthermore, in multivariate analysis, only ΔsBP was the independent factor associated with ΔUAE. Taken together, canagliflozin as add-on therapy to teneligliptin improves glycemic control in a Δglucagon-independent manner and reduces UAE in a ΔsBP-dependent manner in Japanese subjects with T2DM.
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Affiliation(s)
- Yoshiro Fushimi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Junpei Sanada
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Yuichiro Iwamoto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Akiko Mashiko
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Megumi Horiya
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | | | - Momoyo Nishioka
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Yuki Kan
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Tomoe Kinoshita
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Seizo Okauchi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Hidenori Hirukawa
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Kenji Kohara
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Shuhei Nakanishi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Kohei Kaku
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
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Sargeant JA, Henson J, King JA, Yates T, Khunti K, Davies MJ. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul) 2019; 34:247-262. [PMID: 31565876 PMCID: PMC6769337 DOI: 10.3803/enm.2019.34.3.247] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022] Open
Abstract
Weight loss is an important goal in the management of several chronic conditions, including type 2 diabetes mellitus, and pharmacological therapies that aid weight loss are appealing. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel glucose-lowering therapies that have been shown to induce clinically significant reductions in body weight. However, this weight loss may not be attributed solely to fat mass (FM). Given the importance of skeletal muscle and lean body mass (LBM) on cardio-metabolic health and physical function, we reviewed the available literature reporting the effects of GLP-1RAs and SGLT2is on body composition. Results demonstrate that, in most circumstances, the weight loss associated with both therapies predominantly comprises a reduction in FM, although significant heterogeneity exists between studies. In over half of the studies identified, the proportion of LBM reduction ranged between 20% and 50% of total weight lost, which is consistent with diet-induced weight loss and bariatric surgery. No clear differences existed between GLP-1RAs and SGLT2is. Consequently, the loss of LBM and skeletal muscle associated with weight loss induced by GLP-1RAs and SGLT2is warrants attention. Strategies to preserve skeletal muscle and improve physical function, for example through structured exercise, are of great importance.
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Affiliation(s)
- Jack Alistair Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - James Adam King
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK
| | - Melanie Jane Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK.
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Moradi-Marjaneh R, Paseban M, Sahebkar A. Natural products with SGLT2 inhibitory activity: Possibilities of application for the treatment of diabetes. Phytother Res 2019; 33:2518-2530. [PMID: 31359514 DOI: 10.1002/ptr.6421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/15/2019] [Accepted: 05/26/2019] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus currently affects as many as 400 million people worldwide, creating a heavy economic burden and stretching health care resources. A dysfunction of glucose homeostasis underlies the disease. Despite advances in the treatment of diabetes, many patients still suffer from complications and side effects; hence, development of more effective treatments for diabetes is still desirable. SGLT2 is the principle cotransporter involved in glucose reabsorption in the kidney. SGLT2 inhibition reduces glucose reabsorption by the kidney and ameliorates plasma glucose concentration. The interest in natural products that can be used for the inhibition of SGLT2 is growing. The flavonoid phlorizin, which can be isolated from the bark of apple trees, has been used as lead structure due to its inhibitory activity of SGLT1 and SGLT2. Some phlorizin-derived synthetic compounds, including canagliflozin, dapagliflozin, empagliflozin, ipragliflozin, and ertugliflozin, are approved by the food and drug administration to treat type 2 diabetes mellitus (T2DM), whereas others are under clinical trials investigation. In addition, other natural product-derived compounds have been investigated for their ability to improve blood glucose control. The present review summarizes the natural products with SGLT2 inhibitory activity, and the synthetic compounds obtained from them, and discusses their application for the treatment of diabetes.
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Affiliation(s)
| | - Maryam Paseban
- Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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29
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Gharaibeh NE, Rahhal MN, Rahimi L, Ismail-Beigi F. SGLT-2 inhibitors as promising therapeutics for non-alcoholic fatty liver disease: pathophysiology, clinical outcomes, and future directions. Diabetes Metab Syndr Obes 2019; 12:1001-1012. [PMID: 31308716 PMCID: PMC6613609 DOI: 10.2147/dmso.s212715] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as a major expanding national and international health problem. Despite numerous investigations using a variety of therapeutic agents, the positive result on any single medication has not been established enough to gain widespread approval. This is in part related to concerns regarding side effects of agents, but is also related to the complex etiology of NAFLD. An often discussed question has been whether insulin resistance that is frequently present in those with NAFLD is a cause of NAFLD or is merely associated with the condition. Nevertheless, it is clear that a very high proportion of patients with NAFLD are obese, have elements of metabolic syndrome, or have type 2 diabetes (T2DM). Also, much progress has been made toward a better understanding of the pathophysiology of NAFLD. Life-style interventions resulting in weight loss remain the foundation for the prevention and treatment of NAFLD. In addition, agents such as Vitamin E and pioglitazone as well as other glycemia-lowering agents including Glucagon Like Peptide-1 (GLP-1) receptor agonists and Sodium Glucose Contransporter-2 inhibitors (SGLT-2i(s)) exhibit positive effects on the clinical course of NAFLD. This narrative review summarizes the current understanding of the diagnosis, epidemiology, and pathophysiology of NAFLD and specifically focuses on the efficacy of SGLT2i(s) as a potentially promising group of agents for the management of patients with NAFLD.
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Affiliation(s)
- Naser Eddin Gharaibeh
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
- Correspondence: Naser Eddin GharaibehDepartment of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, 10900 Euclid Ave., Cleveland, OH44106-4951, USATel +1 443 983 8045Fax +1 216 844 3120Email
| | - Marie-Noel Rahhal
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Leili Rahimi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Faramarz Ismail-Beigi
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
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30
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Kakuda H, Kobayashi J, Sakurai M, Takekoshi N. Residual Effect of Sodium Glucose Cotransporter 2 Inhibitor, Tofogliflozin, on Body Weight After Washout in Japanese Men With Type 2 Diabetes. J Clin Med Res 2018; 11:35-41. [PMID: 30627276 PMCID: PMC6306130 DOI: 10.14740/jocmr3650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 12/25/2022] Open
Abstract
Background We investigated the potential mechanism underlying body weight reduction by the sodium glucose cotransporter 2 (SGLT2) inhibitor, tofogliflozin, during treatment and after subsequent washout. Methods Ten Japanese men with type 2 diabetes (average age: 66.3 years) were orally administered tofogliflozin (20 mg/day) for 8 weeks followed by a subsequent 8-week washout period (16 weeks). Results Significant reductions were observed in blood glucose, hemoglobin A1c (HbA1c), uric acid, body weight and waist circumference with an increase in high-molecular weight (HMW) adiponectin at 8 weeks. We also evaluated these markers at 16 weeks and found that unlike HbA1c and uric acid, body weight and HMW adiponectin did not return to baseline levels. To clarify the potential mechanism underlying the body weight reduction during treatment with tofogliflozin (8 weeks) and after washout (at 16 weeks), we investigated the correlations between changes from baseline (0 week) in body weight and those in waist circumference (or HMW adiponectin). The changes in body weight between 0 weeks versus 8 weeks were not significantly correlated with those in waist circumference or HMW adiponectin. In contrast, changes in body weight between 0 and 16 weeks did show a significant correlation to those in waist circumference and HMW adiponectin. Conclusion The body weight reduction caused by tofogliflozin may be due to several factors as well as fat reduction at 8 weeks, but is most likely due to fat reduction alone after a subsequent 8 weeks of washout of this agent.
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Affiliation(s)
- Hirokazu Kakuda
- Kakuda Clinic, Takamatsu Na15-1, Kahoku, Ishikawa 929-1215, Japan
| | - Junji Kobayashi
- Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Masaru Sakurai
- Department of Hygiene, Kanazawa Medical University, Ishikawa, Japan
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