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. 2024 Nov 9;16(22):3841.
doi: 10.3390/nu16223841.

Sodium-Glucose Cotransporter 2 Inhibitors Improve Body Composition by Increasing the Skeletal Muscle Mass/Fat Mass Ratio in Patients with Type 2 Diabetes: A 52-Week Prospective Real-Life Study

Sara Volpe  1 , Alfredo Vozza  1 , Giuseppe Lisco  1 , Margherita Fanelli  1 , Davide Racaniello  1 , Alessandro Bergamasco  1 , Domenico Triggiani  1 , Giulia Pierangeli  1 , Giovanni De Pergola  2 , Cosimo Tortorella  1 , Antonio Moschetta  1 , Giuseppina Piazzolla  1
Affiliations

Sodium-Glucose Cotransporter 2 Inhibitors Improve Body Composition by Increasing the Skeletal Muscle Mass/Fat Mass Ratio in Patients with Type 2 Diabetes: A 52-Week Prospective Real-Life Study

Sara Volpe et al. Nutrients. .

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) induce body weight loss, but their effect on skeletal muscle mass (SMM) and strength needs to be better elucidated.

Objectives: This study aimed to evaluate the effects of SGLT2i on SMM in a real-life population setting of patients with type 2 diabetes (T2D). Secondary outcomes included changes in liver steatosis and in anthropometric and glucometabolic parameters.

Methods: Seventy-one patients were treated with SGLT2is as an add-on to metformin for 52 consecutive weeks. Visits were scheduled at baseline (T0) and after 6 (T6) and 12 months of therapy (T12) and included the checking of laboratory tests, measurement of anthropometric parameters, bioimpedance analysis of body composition, and abdominal ultrasound (US).

Results: Fat mass (FM) and visceral adipose tissue (VAT) progressively decreased compared to the baseline (FM: -2.9 ± 0.6 kg at T6; -2.8 ± 0.6 kg at T12; VAT: -0.3 ± 0.1 L at T6; -0.4 ± 0.1 L at T12; all p < 0.01). Changes in SMM were less pronounced (-0.4 ± 0.3 kg at T6, ns; -0.7 ± 0.4 kg at T12, p < 0.05), yielding a beneficial increase in the SMM/FM ratio (+0.3 ± 0.05 at T6 and +0.2 ± 0.05 at T12, all p < 0.01). No significant changes in sarcopenia, sarcopenic obesity, fat-free mass, muscle strength, and water compartments were observed at the end of the follow-up period. Anthropometric and glucometabolic parameters, insulin resistance, liver enzymes, and biometric indices and US grading of hepatic steatosis improved throughout this study.

Conclusions: In a real-life setting, SGLT2i therapy is associated with weight loss attributable to FM rather than SMM loss without any relevant deterioration in muscle strength. In addition, SGLT2is proved to have beneficial effects on steatotic liver disease.

Keywords: body composition; fat mass; real-life study; sarcopenia; sarcopenic obesity; skeletal muscle mass; sodium glucose transporter 2 inhibitors (SGLT2is); type 2 diabetes; visceral adipose tissue.

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Conflict of interest statement

Giuseppina Piazzolla is a Member of the Editorial Board of Nutrients, Nutrition and Diabetes Section. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Percentage of patients with different degrees of steatosis at baseline.
Figure 2
Figure 2
Values are expressed as percent change from baseline (T0). Change vs. T0: * p < 0.05; # p < 0.01. Abbreviations: HOMA-IR: Homeostasis Model Assessment of Insulin Resistance; LDL: low-density lipoprotein.
Figure 3
Figure 3
Values are expressed as percent change from baseline (T0). Change vs. T0: # p < 0.01. Abbreviations: ALT: alanine aminotransferase; GGT: gamma-glutamyl transferase; FLI: Fatty Liver Index.
Figure 4
Figure 4
Values are expressed as percentage of patients with different degrees of steatosis over the study period.
Figure 5
Figure 5
Values are expressed as percent change from baseline (T0). Change vs. T0: * p < 0.05; # p < 0.01. Abbreviations: ECW: extracellular water; TBW: total body water.
Figure 6
Figure 6
Values are expressed as percent change from baseline (T0). Change vs. T0: * p < 0.05; # p < 0.01. Abbreviations: FM: fat mass; VAT: visceral adipose tissue.
See this image and copyright information in PMC

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