The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Yokohama, Japan.
Department of Endocrinology and Metabolism, Yokohama City University, Yokohama, Japan.
Diabetes Obes Metab. 2021 Dec;23(12):2614-2622. doi: 10.1111/dom.14508. Epub 2021 Aug 12.
To characterize the long-term changes in body composition associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.
In this multicentre, single-arm, open-label study, 107 patients with type 2 diabetes were treated with canagliflozin 100 mg, as add-on therapy, for 12 months. Body composition was measured with a body composition analyser (T-SCAN PLUS) using the impedance method to prospectively analyse changes in body components, including percentage of body fat, body fat mass, total body water, muscle mass and mineral mass. Estimated plasma volume (PV) was calculated using the Kaplan formula.
Body weight showed a significant decrease from 1 month to 12 months of treatment with canagliflozin, with a higher rate of decrease in body fat in body composition. A significant decrease in mineral mass was also observed, but its rate was low. Following treatment with canagliflozin, changes in total body water did not affect intracellular water, and a significant decrease in extracellular water, including plasma components, was observed early and was sustained up to 12 months. Protein mass, a component of muscle mass, was not affected, with only a slight decrease in water volume observed.
Canagliflozin decreased extracellular fluid and PV in addition to decreasing fat in the body via calorie loss resulting from urinary glucose excretion. This study suggested that SGLT2 inhibitors might reduce body weight by regulating fat mass or water distribution in the body and might have cardiac and renal protective effects by resetting the homeostasis of fluid balance.
描述钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂相关的长期身体成分变化。
在这项多中心、单臂、开放标签研究中，107 例 2 型糖尿病患者接受卡格列净 100mg 作为附加治疗，治疗 12 个月。采用阻抗法的体成分分析仪（T-SCAN PLUS）前瞻性分析身体成分的变化，包括体脂百分比、体脂量、总体水、肌肉量和矿物质量。估计血浆容量（PV）采用 Kaplan 公式计算。
卡格列净治疗 1 个月至 12 个月时体重明显下降，体成分中体脂下降速度更快。矿物质量也明显下降，但下降速度较慢。卡格列净治疗后，总体水的变化不影响细胞内水，细胞外液（包括血浆成分）显著减少，且早期开始并持续至 12 个月。肌肉量的组成部分——蛋白质质量不受影响，仅观察到水容量略有下降。
卡格列净除了通过尿糖排泄导致的热量损失减少体内脂肪外，还减少细胞外液和 PV。本研究表明，SGLT2 抑制剂可能通过调节体内脂肪量或水分布来减轻体重，并通过重置液体平衡的内稳态发挥心脏和肾脏保护作用。
