Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Feb 26;12(2):e7110.
doi: 10.7759/cureus.7110.

Type 2 Diabetes Remission and Substantial Body Weight Reduction Achieved with Metformin and a Sodium-Glucose Cotransporter 2 Inhibitor

Seigo Sugiyama  1 , Hideaki Jinnouchi  1 , Kunio Hieshima  1 , Noboru Kurinami  1 , Katsunori Jinnouchi  1
Affiliations
Case Reports

Type 2 Diabetes Remission and Substantial Body Weight Reduction Achieved with Metformin and a Sodium-Glucose Cotransporter 2 Inhibitor

Seigo Sugiyama et al. Cureus. .

Abstract

The overall goal in the treatment of type 2 diabetes mellitus (T2DM) is remission. However, the effects of a sodium-glucose cotransporter 2 inhibitor (SGLT2i) on remission of T2DM are unknown. We herein report a case involving an overweight 43-year-old man who completely recovered from T2DM after SGLT2i therapy (dapagliflozin at 5 mg/day). In the pretreatment period, he had a body mass index (BMI) of 26.0 kg/m2, hemoglobin A1c (HbA1c) concentration of 10.3%, advanced insulin resistance, pancreatic β-cell dysfunction, and fatty liver. Eighteen months after comprehensive therapy, including the administration of an SGLT2i and metformin, his BMI had decreased to 21.3 kg/m2 and his glycemic control was almost normal (HbA1c of 5.3%) despite discontinuation of all hypoglycemic medications. This report is the first to propose the usefulness of the combination therapy of SGLT2i and metformin for achieving normal body weight and remission of newly diagnosed T2DM in a real-world clinical situation.

Keywords: diabetes remission; insulin resistance; sodium-glucose cotransporter 2 inhibitor; types 2 diabetes; weight reduction.

PubMed Disclaimer

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Electrocardiogram
Figure 2
Figure 2. Chest radiograph
Figure 3
Figure 3. Abdominal ultrasound images before therapy
A: Liver images; B: Liver and right kidney image, white arrow indicates kidney calcification; C: gallbladder image, yellow arrows indicated a gallbladder polyp; D: pancreas images
Figure 4
Figure 4. Changes in abdominal and liver fat accumulation after remission of diabetes
Fat scan images and abdominal computed tomography images before therapy and after remission of diabetes. Blue areas indicated subcutaneous fat and red areas indicated visceral fat assessed by fat scan; VFA: visceral fat area (cm2), SFA: subcutaneous fat area (cm2). White arrows indicate the abdominal subcutaneous fat accumulation and yellow arrows indicate fatty liver. A: Fat scan image before therapy; B: Fat scan image after remission; C: Liver and spleen image before therapy; D: Liver and spleen image after remission
Figure 5
Figure 5. Time course of changes in body weight and HbA1c during post-discharge outpatient care
BMI: body mass index; BW: body weight; HbA1c: hemoglobin A1c; SGLT2: sodium-glucose cotransporter-2 Black arrow indicates achieving a body weight of 70 kg, gray arrows indicate sustained good control of diabetes, blue dotted line indicates the level of ideal body weight, and green dotted line indicates the time point (November 2018) of normalization of both HbA1c and body weight
Figure 6
Figure 6. Changes in glucose and insulin concentrations in 75 g oral glucose tolerance test before and after remission of diabetes
A: Glucose concentrations before therapy; B: Glucose concentrations after remission; C: Insulin concentrations before therapy; D: Insulin concentrations after remission
See this image and copyright information in PMC

References

    1. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus. Progressive requirement for multiple therapies (UKPDS 49) Turner RC, Cull CA, Frighi V, Holman RR, UK Prospective Diabetes Study (UKPDS) Group. https://jamanetwork.com/journals/jama/article-abstract/190204. JAMA. 1999;281:2005–2012. - PubMed
    1. Mann JI, Chisholm A, Galbo H, Richter EA. International Textbook of Diabetes Mellitus. Hoboken, New Jersey: Wiley Blackwell; 2015. Management of diabetes: diet, exercise and drugs; pp. 577–588.
    1. Bennett PH, Knowler WC. Joslin's Diabetes Mellitus. 14th. Boston: Williams & Wilkins; 2005. Definition, diagnosis, and classification of diabetes mellitus and glucose homeostasis; p. 339.
    1. Quantitative relationship between body weight gain in adulthood and incident type 2 diabetes: a meta-analysis. Kodama S, Horikawa C, Fujihara K, et al. https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.12129. Obes Rev. 2014;15:202–214. - PubMed
    1. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. Shulman GI. https://www.nejm.org/doi/full/10.1056/NEJMra1011035. N Engl J Med. 2014;371:1131–1141. - PubMed

Publication types

LinkOut - more resources