Do gliflozins or gliptins improve metabolic risk in patients with type 2 diabetes?

This study compared canagliflozin (Invokana) to teneligliptin (Teneria) for patients with type 2 diabetes (T2D). It found that canagliflozin led to greater improvement in body weight and metabolic outcomes in these patients.

T2D is a health condition of the metabolism. T2D prevents the body from responding well to the hormone insulin, which controls the amount of glucose (sugar) in the blood. T2D is closely connected to obesity, which is another metabolic condition. Both obesity and T2D are also related to the amount of cholesterol and other lipids in the blood, as well as to blood pressure. Higher body weight, blood sugar, blood pressure, and blood lipids are collectively known as metabolic syndrome. Metabolic syndrome can worsen long-term health.

There are a variety of medications available to treat T2D. Gliflozins alter how the kidneys process glucose, causing it to pass out of the body in the urine. Gliflozins such as canagliflozin are also known as SGLT-2 inhibitors. Gliptins such as teneligliptin act on the GLP-1 hormone to decrease appetite and increase insulin. Gliptins are also known as DPP-4 inhibitors. Both gliflozins and gliptins improve blood glucose control. However, these medications’ effect on other aspects of metabolic syndrome is not clear.

This study included 145 patients with T2D from Japan. All the patients had at least one metabolic risk factor. These included being overweight, high systolic or diastolic blood pressure, or raised triglycerides (blood fats), or low high-density (“good”) cholesterol. The patients were not previously using diabetes medication other than metformin (Glucophage). Half of the patients were assigned to take canagliflozin, while the others used teneligliptin. They were followed for 24 weeks.

Significantly more patients taking canagliflozin had an improvement in at least one metabolic symptom (62.2% vs. 31.3%). Significantly more patients taking canagliflozin lost weight (55.9% vs. 10.5%). Weight loss was defined as as losing at least 3% of body weight compared to the start of the study. There was no difference in blood pressure or triglycerides between the two groups.

The canagliflozin group had a small increase in high-density lipoprotein (“good”) cholesterol, which may lower the risk of heart disease.

Glycated hemoglobin (HbA1c) is an indication of blood glucose control over the previous 2-3 months. Patients taking the two medications had similar improvements in HbA1c or blood glucose control.

Side effects were mild in both groups. More patients using canagliflozin were thirsty and needed to urinate frequently.

This study found that canagliflozin helped patients with T2D lose weight compared to teneligliptin. Both medications significantly improved blood glucose control.

The improvement in metabolic risk was specifically in weight loss, not other factors such as blood pressure. Canagliflozin did not improve metabolic risk factors for patients who were not overweight (body mass index below 25 kg/m2).