Can SGLT2 inhibitors improve weight and overall health in patients with diabetes?

This review looked at how SGLT2 inhibitor medications affected the health of patients with type 2 diabetes (T2D). It found that SGLT2 inhibitors improved body weight and heart and liver health in these patients.

T2D is a condition in which the body does not adequately control the amount of glucose (sugar) in the blood. Over time, high blood glucose can damage the kidneys and other organs. T2D is related to obesity. Also, people with T2D more often have high levels of triglycerides (blood fats) and other lipids (fats). High blood lipids increase the risk of heart-related events like heart attacks or strokes. Also, both high blood sugar and high lipids can stress the liver.

There are a number of medications available for people with T2D. SGLT2 inhibitors prevent the kidneys from reclaiming glucose as they filter the blood. Glucose is passed out of the body in the urine, leading to lower blood glucose. Common SGLT2 inhibitors include dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance).

SGLT2 inhibitors are effective at improving blood glucose control. It is not yet clear whether these medications can also improve lipid levels and body weight in patients with T2D.

This review analyzed 36 studies of SGLT2 inhibitors use in a total of 17,561 patients with T2D. Each study compared one SGLT2 inhibitor medication to a placebo. Additionally, some studies looked at both a high dose and a low dose of the medication. 

All SGLT2 inhibitors led to weight loss. Of the studied medications, canagliflozin 100 mg (low dose) and 300 mg (high dose) was the most effective for weight loss.

Five studies looked at triglycerides. Patients using SGLT2 inhibitors had significantly lower levels of triglycerides. High doses of SGLT2 inhibitors were more effective at lowering triglycerides. SGLT2 inhibitors also increased both HDL (“good") cholesterol and LDL (“bad") cholesterol.

Alanine aminotransferase (ALT) is an enzyme used in the liver. High ALT levels in the blood can indicate liver damage. SGLT2 inhibitors were associated with lower blood ALT levels.

This network review found that SGLT2 inhibitors, particularly canagliflozin, can improve body weight. It also found that SGLT2 inhibitors can improve triglyceride levels and liver health.

The cholesterol ratio is generally considered more important than the cholesterol values. Raising both types of cholesterol leads to a similar cholesterol ratio.