Comparison of Visceral Fat Reduction by Ipragliflozin and Metformin in Elderly Type 2 Diabetes Patients: Sub-Analysis of a Randomized-Controlled Study

Masaya Koshizaka, Ko Ishikawa, Ryoichi Ishibashi, Sho Takahashi, Kenichi Sakamoto, Hidetaka Yokoh, Yusuke Baba, Shintaro Ide, Kana Ide, Takahiro Ishikawa, Shunichiro Onishi, Kazuki Kobayashi, Minoru Takemoto, Takuro Horikoshi, Ryota Shimofusa, Yoshiro Maezawa, Koutaro Yokote
Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders 2020 October 24

INTRODUCTION: To compare the effects of ipragliflozin, a sodium-glucose transporter 2 inhibitor, with those of metformin on visceral fat (as well as muscles and bones) in Japanese elderly patients with type 2 diabetes (T2D), we conducted a sub-analysis of a prospective, multicenter, blinded-endpoint randomized-controlled study.

METHODS: In total, 103 patients with T2D (body mass index ≥ 22 kg/m2 ; glycated hemoglobin, 7-10%) and being treated with sitagliptin (a dipeptidyl peptidase-4 inhibitor) were included and randomized to receive ipragliflozin or metformin. The primary outcome was the change in visceral fat area measured using computed tomography 24 weeks following treatment. The secondary outcomes included changes in subcutaneous and total fat area, muscle volume, bone density measured using computed tomography, handgrip strength, bone markers, plasma glucose, insulin, homeostasis model assessment (HOMA)2-beta, HOMA2-R, glycated hemoglobin, lipid panel, uric acid, blood pressure, adiponectin, and high-sensitivity C-reactive protein. All patients aged 65-74 years were selected for sub-analysis.

RESULTS: The sub-analysis included 15 and 14 patients in the ipragliflozin and metformin groups, respectively. The patients' backgrounds were well balanced. Visceral fat area reduction was greater in the ipragliflozin group than in the metformin group (- 10.58% vs. - 6.93%; P = 0.034). There were significant differences in the changes in bone absorption markers, uric acid, and total cholesterol levels between the groups.

CONCLUSION: Ipragliflozin significantly reduced the visceral fat area compared with metformin when added to sitagliptin in elderly patients with T2D. Long-term and large-scale studies are required to elucidate whether ipragliflozin is suitable for elderly patients.

TRIAL REGISTRATION: The study was registered at (UMIN-ID: UMIN 000015170).

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