Sodium glucose cotransporter 2 (SGLT2) inhibitors improve hyperglycemia in patients with type 2 diabetes mellitus (T2DM) by increasing urinary glucose excretion. In addition to their antihyperglycemic effect, SGLT2 inhibitors also reduce body weight and fat mass in obese and overweight patients with T2DM. However, whether or not SGLT2 inhibitors similarly affect body composition of non-obese patients with T2DM remains unclear. In this study, we investigated the effect of the SGLT2 inhibitor ipragliflozin on body composition in a Goto-Kakizaki (GK) rat model of non-obese T2DM. GK rats were treated with ipragliflozin once daily for 9 weeks, starting at 23 weeks of age. Body composition was then analyzed using dual-energy X-ray absorptiometry. Treatment with ipragliflozin increased urinary glucose excretion, reduced hemoglobin A1c (HbA1c) levels and suppressed body weight gain as the dose increased. Body composition analysis revealed that body fat mass was lower in the ipragliflozin-treated groups than in the control group, while lean body mass and bone mineral contents were comparable between groups. Thus, an SGLT2 inhibitor ipragliflozin was found to promote preferential loss of fat mass in a rat model of non-obese T2DM. Ipragliflozin might also promote preferential loss of fat in non-obese patients with T2DM.Key words ipragliflozin; sodium glucose cotransporter 2 (SGLT2) inhibitor; body composition; anti-diabetic drug; type 2 diabetes mellitus Type 2 diabetes mellitus (T2DM) is characterized by either or both disturbed insulin secretion from pancreatic β-cells or insufficient action of insulin (insulin resistance) in peripheral tissues.1,2) Treatment of T2DM typically starts with diet and exercise to reduce excess body weight, which is effective for glycemic control, 3) as extra fat is known to increase insulin resistance.4) If glycemic control cannot be effectively achieved through diet and exercise, treatment then progresses to the use of several types of oral antihyperglycemic drug. 5,6) However, most of these compounds either induce weight gain (insulin, sulfonylureas, glinides, and thiazolidinediones) or help maintain current weight (metformin, α-glucosidase inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors).5,6) Achieving weight loss along with fat loss using such medications has thus far proven difficult.
7)Sodium glucose cotransporter 2 (SGLT2) inhibitors have recently been developed as antidiabetic drugs. 8,9) SGLT2, a low-affinity and high-capacity glucose transporter, is expressed specifically on the luminal surface of cells in the S1 segment of the proximal tubule 10) and reabsorbs approximately 90% of glucose in the glomerular filtrates in normal glucose-tolerant individuals.
8)SGLT2 inhibitors prevent this reabsorption, thereby increasing urinary glucose excretion and subsequently decreasing blood glucose levels. Treatment with SGLT2 inhibitors improves glycemic parameters and is associated with reduction in body weight in patients with T2DM. 11,12) Further, reduction of waist circumference...