An SGLT-2 inhibitor drug plus a moderately calorie-restrictive diet may be the best approach for achieving diabetes remission.
- About 828 million adults around the world have diabetes, and 90%
have type 2 diabetes.
- Only about 5% of people with type 2 diabetes will achieve remission.
- A new study has found a combination of an SGLT-2 inhibitor drug and
a moderately calorie-restrictive diet provides higher rates of type 2
diabetes remission compared to just calorie restriction alone.
Researchers estimate
that about 828 million adultsTrusted Source around
the world live with diabetes,
with 90% of them having type 2 diabetes.
Recent studies predict
the number of people globally living with diabetes will grow to at least 1.3 billion by 2050Trusted Source.
While type 2 diabetes
can be managed with medications and lifestyle
changes, only about 5% of people with this form of diabetes will
ever achieve disease remission.
“Diabetes has been
considered as an incurable illness and is dependent on medication for [a]
lifetime,” Xiaoying Li, MD, PhD, professor and director of the
Department of Endocrinology and Metabolism at Zhongshan Hospital Fudan
University in China explained to Medical News Today.
“Diabetes complications
gradually occur as diabetes progresses. Thus, it is important to find a
strategy to stop the progression of diabetes for prevention of the
complications,” he added.
Li is the lead author of
a new study recently published in The BMJTrusted
Source, which found that the combination of a sodium
glucose cotransporter 2 (SGLT-2) inhibitor drug — commonly used to
treat type 2 diabetes — with a moderately calorie-restrictive
diet provides higher rates of remission compared to just calorie
restriction alone.
This study received
funding from biopharmaceutical company AstraZeneca.
Diabetes
treatment: Why focus on dapagliflozin plus calorie restriction?
For this study,
researchers focused on the SGLT-2 drug dapagliflozin, and
how it worked in combination with a calorie-restricted diet.
“SGLT-2 inhibits are a
class of medications that inhibit glucose reabsorption from nephronTrusted Source and
increase glucose loss from the urine,” Li explained. “It has been reported that
body weight reduction in type 2 [diabetes] patients with overweight or obesity
is associated with diabetes remission by bariatric surgery and
very low calorie restriction.”
“We hypothesized that
SGLT-2 inhibitor plus moderate calorie restriction could achieve more body
weight reduction,” he continued. “On the other hand, SGLT-2 could produce more
metabolic benefits and remodel metabolic state, which could help
[improve] insulin
resistance and beta cell function.”
To conduct the study,
researchers recruited 328 people between the ages of 20-70 from China who had
type 2 diabetes for more than 6 years and visited medical centers from June
2020 to January 2023.
All study participants
had a starting body
mass index (BMI) greater than 25, and were not taking any diabetes
medications other than metformin.
Scientists randomly
assigned participants into two groups — one taking dapagliflozin with a
moderate calorie-restricted diet, and one taking a placebo and following the
diet.
The calorie-restrictive
diet lowered participants’ normal daily calories between 500-750 kilocalories
(kcal).
Study participants were
asked to keep a detailed food journal and encouraged to take part in 150
minutes of brisk walking each week or more than 10,000 steps each day.
They also received
dietary counseling from dieticians on a monthly basis, as well as messages or
phone calls every 2 weeks for the first 6 months, to help support them.
SGLT-2
plus calorie restriction: 44% achieve diabetes remission
Upon analysis, Li and
his team found that after 12 months, 44% of study participants in the
combination dapagliflozin and calorie restriction group achieved type 2
diabetes remission, compared to 28% in the placebo group.
“The remission rate in
patients receiving dapagliflozin plus calorie restriction (44%) is
significantly greater than those receiving calorie restriction alone (28%),” Li
detailed.
“The chance to achieve
diabetes remission in patients receiving dapagliflozin plus calorie restriction
is increased by 56%, as compared with those receiving calorie restriction
alone,” he noted.
Researchers also
discovered that participants in the combination dapagliflozin group also
experienced a greater reduction in body weight and insulin resistance, as well
as benefits to body
fat mass, systolic blood pressureTrusted Source,
and cholesterol
levels.
“It is thought that
those metabolic changes including body weight, insulin resistance, body fat
mass, and systolic blood pressure are associated with improvement of
cardiovascular outcomes and kidney outcomes, which are possibly associated with
diabetes remission,” Li said.
Diabetes
treatment: Recognizing the potential of dapagliflozin
MNT spoke
with Jennifer Cheng, DO, chief of endocrinology at Hackensack
Meridian Jersey Shore University Medical Center in New Jersey, about this
study.
“It makes sense that a
diabetes medication, dapagliflozin, with calorie restriction would achieve
better remission for type 2 diabetes than calorie restriction alone,” Cheng,
who was not involved in the study, explained.
“Dapagliflozin is a
SGLT-2 class of medication, which helps your kidneys remove more sugar from
your blood through urination. At times, it also enables mild weight loss,” she
noted.
“It is understandable
that this may cause better glucose control for people who are taking the
medication,” she continued. “More and more people are starting dapagliflozin
for heart
failure, and other indications, so it is good to know that sugar
control may occur as a side effect for patients who are taking it for other
indications.”
“Diabetes is an
under-recognized disease that many people do not even realize they have,” Cheng
added. “It can cause a significant health burden as well as financial burden if
left untreated. It is important to obtain new treatments because of the
significant financial burden that diabetes may present for patients. Early
treatment and better control of diabetes prevents complications of diabetes
later in life.”
SGLT-2
and GLP-1 combo: The next step in diabetes research?
MNT also
spoke with Pouya Shafipour, MD, a board-certified family and obesity
medicine physician at Providence Saint John’s Health Center in Santa Monica,
CA, about this study.
Shafipour, who was also
not involved in the research, commented that he was not surprised by its
results:
“Diabetes,
as we know, is on the rise, so it is a major health issue. It not only just
impacts blood sugar, but also kidney functionTrusted Source, heart diseaseTrusted Source, Alzheimer’s
[disease risk], [the] eyes, nervous
system, [and] neuropathyTrusted Source, so
it almost encompasses, from head to toe, the entire body.”
“The more we can find
efficient drugs before people go on insulin because
once someone goes on insulin, then it’s almost the end of the line — if someone
has been diabetic for too long [they] become insulin dependent,” he continued.
“The more we can find drugs that are very effective earlier on, we keep the
pancreatic function when [improving] insulin sensitivity.”
When it comes to the
next steps in this type of research, Shafipour said there are some medications
in the research pipeline that are a combination of SGLT-2 drugs and glucagon-like
peptide-1 (GLP-1) receptor agonists. Ozempic and Zepbound are
both examples of GLP-1 medications.
“Both of these classes
have shown a lot of benefits in terms of diabetic control, as well as weight
loss,” he explained. “Obviously, the GLP-1s have more weight loss effect, but
if we can see some data that uses both these classes together, that would be
great.”
No comments:
Post a Comment