Dapagliflozin and calorie restriction show higher remission rates in type 2 diabetes

Adults with obese or weight problems and sort 2 diabetes who’re given the sodium glucose cotransporter 2 (SGLT-2) inhibitor drug dapagliflozin alongside reasonable calorie restriction obtain a lot greater charges of remission in contrast with calorie restriction alone, finds a trial printed by The BMJ in the present day.

The researchers say this research supplies a sensible technique to realize remission for sufferers with early kind 2 diabetes.

Kind 2 diabetes impacts over 400 million adults worldwide. It is not essentially a everlasting situation and might be reversed by intensive weight administration, however the best strategies of weight reduction, similar to a really low power weight loss program or bariatric surgical procedure, aren’t straightforward to implement.

In addition to serving to to decrease blood sugar ranges, SGLT-2 inhibitors also can result in weight reduction, however their impact alongside calorie restriction on diabetes remission has not but been investigated in a randomised managed trial.

To deal with this, researchers carried out a trial involving 328 sufferers with kind 2 diabetes of lower than six years’ length at 16 centres in mainland China from 12 June 2020 to 31 January 2023.

Individuals had been aged 20-70 years with a physique mass index (BMI) better than 25 and weren’t taking any anti-diabetic medicine apart from metformin.

After excluding sufferers with a variety of pre-existing circumstances, a historical past of gastric surgical procedure, and people taking weight reduction medicine, members had been randomly assigned to both reasonable calorie restriction (a discount of 500-750 kcal/day) with dapagliflozin 10mg/day or placebo for 12 months. 

All members obtained dietary counselling all through the trial, had been requested to maintain a dietary log, and had been inspired to be bodily energetic (150 minutes of brisk strolling each week or greater than 10,000 steps per day). 

Diabetes remission was outlined as sustaining regular blood sugar ranges for no less than two months after stopping anti-diabetic medicine.

At 12 months, 44% of members within the calorie restriction plus dapagliflozin group had been in remission in contrast with 28% within the placebo group, and there was a considerably better discount in physique weight and insulin resistance within the dapagliflozin group. The outcomes additionally confirmed advantages of dapagliflozin on physique fats mass, systolic blood strain, and levels of cholesterol.

No important variations in hostile occasions had been seen between the 2 teams.

The researchers acknowledge some trial limitations. As an example, their findings can’t be generalised to sufferers with kind 2 diabetes for greater than six years or to different races or ethnic teams, and whole power expenditure was not assessed.

Nonetheless, they are saying the structured dietary programme was practicable and possible in a medical setting and members had good adherence to the mixture of SGLT-2 inhibitor and reasonable calorie restriction. Outcomes had been additionally comparable after additional evaluation, suggesting that they stand up to scrutiny.

As such, they conclude: “Our multicenter, double blind and randomised trial confirmed that the mixed routine of dapagliflozin and common calorie restriction was efficient in attaining remission of diabetes, reducing physique weight, and bettering metabolic danger elements amongst obese or overweight sufferers with kind 2 diabetes.”

This mixed technique is efficient however questions stay, say UK researchers in a linked editorial. For instance, ought to such glucose reducing medicine be discontinued on the level of remission, and might particular drug mechanisms be harnessed for a extra individualised strategy to remission of kind 2 diabetes? 

Regardless of these uncertainties, they notice that SGLT-2 inhibitors are actually co-first line medicine (with metformin) for a lot of sufferers with kind 2 diabetes. “This research helps extra analysis into mixed approaches to attaining profitable and sustainable remission of kind 2 diabetes,” they conclude.