Published online Mar 15, 2024. doi: 10.4239/wjd.v15.i3.463
Peer-review started: October 28, 2023
First decision: December 29, 2023
Revised: January 2, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 15, 2024
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with moderate efficacy in glycemic control, and a potential for weight loss through their glycosuric effects, which are helpful for patients with diabesity - diabetes consequent to obesity. Marked cardiovascular and reno-protective effects with the use of SGLT-2i were proven by multiple randomised controlled trials (RCTs), observational studies and various systematic reviews.
Head-to-head comparison of the real-world data on the comparative efficacy and safety of individual SGLT-2i medications is rather sparse and needs more reports to appraise the benefits shown by the above studies.
To procure the comparative efficacy, safety, and adverse effect profiles of SGLT2i drugs in the clinical practice settings to make better therapeutic decision making as RCTs and prospective observational studies are often biased with rigorous monitoring of patients and the study results that wouldn’t always reflect the real-world medical practice.
We evaluated the comparative efficacy data of 3 SGLT-2i drugs (dapagliflozin, canagliflozin, and empagliflozin) at full doses, used for treating patients with type 2 diabetes mellitus (T2DM) only. Reduction of glycated hemoglobin, body weight, blood pressure, and urine albumin creatinine ratio were recorded, and the adverse effects were documented retrospectively from the clinical records.
This real-world data from 467 patients with T2DM showed remarkable improvements in diabesity and cardiometabolic outcomes with all the three SGLT-2i agents with a tendency for renal protection (improvement of albuminuria) in those on canagliflozin. These drugs are reasonably safe with acceptably mild side effects profiles when used judiciously in patients with diabesity.
We found that SGLT-2i class of medications are very useful for the management of diabesity with improvements cardiometabolic outcomes in the real-world settings as proven by previous RCTs and observational studies.
Management of diabesity is often a clinical dilemma in the context of optimal glycemic control as several antidiabetic agents including insulins tend to cause weight gain with a potential for worsening of diabesity in a vicious cycle. SGLT-2i group of drugs improves glycemic control and cause weight loss when used in patients with diabesity. Moreover, SGLT-2i medications are useful in improving cardiometabolic outcomes and renal protection in patients with T2DM. We studied the comparative efficacy of dapagliflozin, empagliflozin and canagliflozin using a retrospective data from our hospital which revealed significant improvements in body weight, blood pressure, and glycated hemoglobin, with canagliflozin also showing improvement in albuminuria. They were also reasonably safe with acceptable side effect profile when used in the appropriate clinical context.