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. 2025 Jul 24;69(3):e240485.
doi: 10.20945/2359-4292-2024-0485.

Effect of SGLT2 inhibitors on thiazolidinedione-induced changes in the volume status of patients with type 2 diabetes mellitus: a 6-month follow-up prospective study

Yagmur Busra Unlusoy  1 , Oguzhan Sıtkı Dizdar  2 , Ali İhsan Gunal  3
Affiliations

Effect of SGLT2 inhibitors on thiazolidinedione-induced changes in the volume status of patients with type 2 diabetes mellitus: a 6-month follow-up prospective study

Yagmur Busra Unlusoy et al. Arch Endocrinol Metab. .

Abstract

Objective: To ascertain the impact of combining sodium-glucose cotransporter 2 inhibitors (SGLT2is) with thiazolidinediones on fluid balance in patients with type 2 diabetes mellitus.

Methods: This prospective study followed patients over a 6-month period, with data collected at three time points. The study commenced with the administration of pioglitazone on the same day. At the 3-month mark of the study, SGLT2is (dapagliflozin or empagliflozin) were subsequently integrated into the patients' treatment regimens. At each time point, bioimpedance spectroscopy was employed to the volume status of the patients, and an assessment of their glycemic, renal, and lipid parameters was conducted. Their fluid status was evaluated on the basis of the overhydration value and the relative hydration index.

Results: The study sample consisted of 60 type 2 diabetes mellitus patients with a mean age of 52.5 years. While notable increases in the mean overhydration value and relative hydration index were observed during the initial 3-month period (p < 0.001), a significant decline was evident in the second 3-month period (p < 0.001). However, no significant change in the adipose tissue index, fat mass, or body cell mass was found at the 6-month follow-up. Significant improvements were achieved in liver function test results, glycemic parameters, and the lipid profile. Renal parameters did not change significantly during the 6-months of follow-up.

Conclusion: SGLT2is have been shown to be effective in improving fluid retention associated with thiazolidinediones and in maintaining euvolemic fluid status.

Keywords: Sodium-Glucose Transporter 2 Inhibitors; thiazolidinediones; water-electrolyte balance.

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Conflict of interest statement

Conflicts of interests: the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Flow of patients through the trial.
Figure 2
Figure 2
Changes in the overhydration value and relative hydration index from baseline at 6 months.
Figure 3
Figure 3
Changes in laboratory values from baseline at 6 months.
See this image and copyright information in PMC

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