1
|
Hasan I, Rashid T, Jaikaransingh V, Heilig C, Abdel-Rahman EM, Awad AS. SGLT2 inhibitors: Beyond glycemic control. J Clin Transl Endocrinol 2024; 35:100335. [PMID: 38525377 PMCID: PMC10957445 DOI: 10.1016/j.jcte.2024.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Multiple randomized controlled trials have extensively examined the therapeutic effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors, ushering in a transformative approach to treating individuals with type 2 diabetes mellitus (DM). Notably, emerging reports have drawn attention to the potential positive impacts of SGLT2 inhibitors in nondiabetic patients. In an effort to delve into this phenomenon, a comprehensive systematic literature review spanning PubMed (NLM), Medline (Ovid), and Cochrane Library, covering publications from 2000 to 2024 was undertaken. This systematic review encompassed twenty-six randomized control trials (RCTs) involving 35,317 participants. The findings unveiled a multifaceted role for SGLT2 inhibitors, showcasing their ability to enhance metabolic control and yield cardioprotective effects through a reduction in cardiovascular death (CVD) and hospitalization related to heart failure (HF). Additionally, a renalprotective effect was observed, evidenced by a slowdown in chronic kidney disease (CKD) progression and a decrease in albuminuria. Importantly, these benefits were coupled with an acceptable safety profile. The literature also points to various biological plausibility and underlying mechanistic pathways, offering insights into the association between SGLT2 inhibitors and these positive outcomes in nondiabetic individuals. Current research trends indicate a continual exploration of additional role for SGLT2 inhibitors in. Nevertheless, further research is imperative to fully elucidate the mechanisms and long-term outcomes associated with the nondiabetic use of SGLT2 inhibitors.
Collapse
Affiliation(s)
- Irtiza Hasan
- University of Florida College of Medicine-Jacksonville, FL, USA
| | - Tasnuva Rashid
- University of Florida College of Medicine-Jacksonville, FL, USA
| | | | - Charles Heilig
- University of Florida College of Medicine-Jacksonville, FL, USA
| | | | - Alaa S. Awad
- University of Florida College of Medicine-Jacksonville, FL, USA
| |
Collapse
|
2
|
Khiali S, Taban-Sadeghi M, Sarbakhsh P, Khezerlouy-Aghdam N, Rezagholizadeh A, Asham H, Entezari-Maleki T. SGLT2 Inhibitors' Cardiovascular Benefits in Individuals Without Diabetes, Heart Failure, and/or Chronic Kidney Disease: A Systematic Review. J Clin Pharmacol 2023; 63:1307-1323. [PMID: 37455561 DOI: 10.1002/jcph.2311] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Despite the growing body of evidence regarding the beneficial cardiovascular effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors, clinical data in individuals without diabetes, heart failure (HF), and/or chronic kidney disease (CKD) is limited. A systematic review of the literature was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, from database inception until May 4, 2023, to explore new evidence of SGLT2 inhibitors' cardiovascular benefits in individuals without diabetes, HF, and/or CKD. A total of 1156 individuals from 14 studies (13 randomized controlled trials and 1 nonrandomized study) were included. The results showed the benefits of SGLT2 inhibitors on blood pressure, weight, and body mass index in this population with an acceptable safety profile. The current evidence supports the potential role of SGLT2 inhibitors as primary prevention in individuals without diabetes, HF, and/or CKD. This review may shed light on the use of SGLT2 inhibitors in conditions such as stage A HF and metabolic syndrome. The literature trend is going toward uncovering SGLT2 inhibitors' role in stage B HF, different types of myocardial infarction, and cardiac arrhythmias.
Collapse
Affiliation(s)
- Sajad Khiali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Afra Rezagholizadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hila Asham
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
3
|
Stephens JA, Hernandez-Sarabia JA, Sharp JL, Leach HJ, Bell C, Thomas ML, Buryznska AZ, Weaver JA, Schmid AA. Adaptive yoga versus low-impact exercise for adults with chronic acquired brain injury: a pilot randomized control trial protocol. Front Hum Neurosci 2023; 17:1291094. [PMID: 38077184 PMCID: PMC10701427 DOI: 10.3389/fnhum.2023.1291094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 02/12/2024] Open
Abstract
Background Each year, millions of Americans sustain acquired brain injuries (ABI) which result in functional impairments, such as poor balance and autonomic nervous system (ANS) dysfunction. Although significant time and energy are dedicated to reducing functional impairment in acute phase of ABI, many individuals with chronic ABI have residual impairments that increase fall risk, decrease quality of life, and increase mortality. In previous work, we have found that yoga can improve balance in adults with chronic (i.e., ≥6 months post-injury) ABI. Moreover, yoga has been shown to improve ANS and brain function in healthy adults. Thus, adults with chronic ABI may show similar outcomes. This protocol details the methods used to examine the effects of a group yoga program, as compared to a group low-impact exercise, on primary and secondary outcomes in adults with chronic ABI. Methods This study is a single-blind randomized controlled trial comparing group yoga to group low-impact exercise. Participants must be ≥18 years old with chronic ABI and moderate balance impairments. Group yoga and group exercise sessions occur twice a week for 1 h for 8 weeks. Sessions are led by trained adaptive exercise specialists. Primary outcomes are balance and ANS function. Secondary outcomes are brain function and structure, cognition, quality of life, and qualitative experiences. Data analysis for primary and most secondary outcomes will be completed with mixed effect statistical methods to evaluate the within-subject factor of time (i.e., pre vs. post intervention), the between-subject factor of group (yoga vs. low-impact exercise), and interaction effects. Deductive and inductive techniques will be used to analyze qualitative data. Discussion Due to its accessibility and holistic nature, yoga has significant potential for improving balance and ANS function, along with other capacities, in adults with chronic ABI. Because there are also known benefits of exercise and group interaction, this study compares yoga to a similar, group exercise intervention to explore if yoga has a unique benefit for adults with chronic ABI.Clinical trial registration:ClinicalTrials.gov, NCT05793827. Registered on March 31, 2023.
Collapse
Affiliation(s)
- Jaclyn A. Stephens
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, United States
- Sharp Analytics, LCC, Fort Collins, CO, United States
| | | | - Julia L. Sharp
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | | | | | - Michael L. Thomas
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, United States
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Agnieszka Z. Buryznska
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, United States
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Jennifer A. Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
- Center for Healthy Aging, Fort Collins, CO, United States
| |
Collapse
|
4
|
Hanson P, Randeva H, Cuthbertson DJ, O'Hare PJ, Parsons N, Chatha K, Reidy G, Weickert MO, Barber TM. The DAPA-DIET study: Metabolic response to Dapagliflozin combined with dietary carbohydrate restriction in patients with Type 2 Diabetes Mellitus and Obesity-A longitudinal cohort study. Endocrinol Diabetes Metab 2022; 5:e381. [PMID: 36266774 PMCID: PMC9659664 DOI: 10.1002/edm2.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The cardio-renal benefits of sodium glucose-like transporter 2 inhibitor (SGLT2i) therapies have been demonstrated in patients with and without type 2 diabetes. However, no studies have explored the long-term metabolic effects of SGLT2i, combined with dietary carbohydrate restriction. Our primary objective was to describe long-term changes in weight, energy expenditure, appetite and body composition after 12 months of Dapagliflozin therapy, with carbohydrate restriction, in people with type 2 diabetes and obesity. Our secondary objective was to assess changes in adiponectin and leptin. METHOD This was a 12-month cohort study in a secondary care setting. Participants (n = 18) with type 2 diabetes (T2D) and class 3 obesity underwent baseline indirect calorimetry for determination of 24-h energy expenditure, body composition, fasting serum leptin and adiponectin levels, and appetitive assessments. Following initiation of Dapagliflozin (and dietary carbohydrate restriction), measurements were repeated at monthly intervals up to 12 months. RESULTS Mean starting weight of participants was 129.4 kg (SD 25.9), mean BMI 46.1 kg/m2 (SD 8.3) and mean HbA1c 53.9 mmol/mol (14.1). Seventeen participants completed the study; after 12 months of Dapagliflozin and dietary carbohydrate restriction, mean weight loss was 8.1 kg (SD 11.3 kg; p = .009). This was mediated by reduced fat mass (mean loss, 9.9 kg; SD 10.4 kg; p = .002) associated with reduced serum leptin at 12 months (mean reduction 11,254 pg/ml; SD 16,075; p = .011). There were no significant changes in self-reported appetite, 24-h energy expenditure or serum adiponectin during follow-up. CONCLUSION In this study, combined Dapagliflozin therapy and carbohydrate restriction in patients with T2D and obesity resulted in a significant reduction of body weight and fat mass at 12 months without any discernible changes in energy expenditure or appetite. These results offer a scientific and clinical rationale to conduct an exploratory trial investigating the effects of a low carbohydrate diet combined with SGLT2 inhibitors in patients with T2D.
Collapse
Affiliation(s)
- Petra Hanson
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Harpal Randeva
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Dan J. Cuthbertson
- Institute of Cardiovascular and Metabolic MedicineUniversity of LiverpoolLiverpoolUK,Department of EndocrinologyLiverpool University Hospital NHS Foundation TrustLiverpoolUK
| | - Paul J. O'Hare
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Nick Parsons
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kamaljit Chatha
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Biochemistry and Immunology DepartmentUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Gemma Reidy
- Biochemistry and Immunology DepartmentUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Martin O. Weickert
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Thomas M. Barber
- Warwick Medical SchoolUniversity of WarwickCoventryUK,Warwickshire Institute for the Study of Diabetes Endocrinology and MetabolismUniversity Hospitals Coventry and WarwickshireCoventryUK
| |
Collapse
|
5
|
Wong J, Chan KY, Lo K. Sodium-glucose co-transporter 2 inhibitors on weight change and cardiometabolic profiles in individuals with overweight or obesity and without diabetes: A meta-analysis. Obes Rev 2021; 22:e13336. [PMID: 34542222 DOI: 10.1111/obr.13336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022]
Abstract
Several meta-analyses have been conducted to evaluate the weight loss effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors in patients with type 2 diabetes, whereas pooled analysis focusing on individuals without diabetes is lacking. The objective of this systematic review and meta-analysis is to evaluate the effect of SGLT-2 inhibitor monotherapy on weight change and cardiometabolic profiles. Multiple databases were searched for randomized controlled trials reporting weight change effect of SGLT-2 inhibitor treatment compared with placebo for more than 12 weeks among individuals with overweight or obesity and without diabetes. A total of eight randomized controlled trials with 750 subjects were identified. SGLT-2 monotherapy was associated with significant reduction in body weight of -2.32 kg, compared to -1.01 kg for placebo, giving a mean difference of -1.31 kg. Significant reductions in body mass index and fasting blood glucose were observed, but not for the changes in waist circumference, fat mass, blood pressure, and lipid profile compared with placebo. SGLT-2 inhibitor monotherapy for 12 weeks or more can result in modest weight loss among people with overweight or obesity and without diabetes. Depending on pre-existing comorbidities or risk factors, SGLT-2 inhibitors can be considered adjuncts in the treatment of obesity.
Collapse
Affiliation(s)
- John Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kwan Yi Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| |
Collapse
|
6
|
Comparison of Five Oral Cannabidiol Preparations in Adult Humans: Pharmacokinetics, Body Composition, and Heart Rate Variability. Pharmaceuticals (Basel) 2021; 14:ph14010035. [PMID: 33418866 PMCID: PMC7825058 DOI: 10.3390/ph14010035] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Data supporting the physiological effects of cannabidiol (CBD) ingestion in humans are conflicting. Differences between CBD preparations and bioavailability may contribute to these discrepancies. Further, an influence of body composition on CBD bioavailability is feasible, but currently undocumented. The aims of this study were to: (1) compare the pharmacokinetics of five oral CBD preparations over 4 h; (2) examine the relationship between body composition and CBD pharmacokinetics; and, (3) explore the influence of CBD on heart rate variability. In total, five preparations of CBD, standardized to 30 mg, were orally administered to 15 healthy men and women (21-62 years) in a randomized, crossover design. Prior to and 60 min following CBD ingestion, heart rate variability was determined. Body composition was assessed using dual energy X-ray absorptiometry. Peak circulating CBD concentration, time to peak concentration, and area under the curve was superior in a preparation comprising 5% CBD concentration liquid. Fat free mass was a significant predictor (R
2 = 0.365, p = 0.017) of time to peak concentration for this preparation. Several heart rate variability parameters, including peak frequency of the high frequency band, were favorably, but modestly modified following CBD ingestion. These data confirm an influence of CBD preparation and body composition on CBD bioavailability, and suggest that acute CBD ingestion may have a modest influence on autonomic regulation of heart rate.
Collapse
|