Clinical Factors Associated with Initial Decrease in Body-Fat Percentage Induced by Add-on Sodium-Glucose Co-transporter 2 Inhibitors in Patient with Type 2 Diabetes Mellitus

BACKGROUND AND OBJECTIVE: Obesity is globally recognized as an important clinical problem and sodium-glucose co-transporter 2 (SGLT2) inhibitors are considered a suitable therapy for obese patients with type 2 diabetes mellitus (T2DM). We examined the clinical factors associated with initial decrease in body-fat percentage (Fat %) induced by SGLT2 inhibitors in patients with T2DM. METHODS: We retrospectively enrolled patients newly treated with SGLT2 inhibitors in addition to ongoing medications at Jinnouchi Hospital between April 2014 and December 2015. We examined the SGLT2 inhibitor-induced change in body composition by using a bioelectrical impedance analyzer (InBody770(®)) before SGLT2 inhibitor administration and after 4 weeks’ treatment. RESULTS: A total of 175 patients with T2DM were enrolled and we analyzed 148 patients. Add-on SGLT2 inhibitor treatment significantly reduced body weight (− 1.04 ± 1.18 kg, p < 0.01), total fat quantity (− 0.62 ± 1.19 kg, p < 0.01), and Fat % (− 0.4 ± 1.4%, p < 0.01). Pretreatment levels of glycated hemoglobin (HbA1c) [odds ratio (OR), 1.61; 95% confidence interval (CI), 1.15–2.25, p < 0.01] and smoking (OR, 2.65; 95% CI, 1.14–6.15, p = 0.02) were significantly associated factors for greater fat-reduction defined as more than 0.4% (median) decrease in Fat % in multivariate logistic regression analysis. In receiver operator characteristic analysis, the cut-off value of pretreatment levels of HbA1c for a greater Fat % decrease was 7.7% (sensitivity 53% and specificity 69%, p < 0.01). CONCLUSION: Additional treatment with SGLT2 inhibitors effectively decreased Fat % in T2DM patients with high HbA1c levels before SGLT2 inhibitor administration. Our results suggest a greater initial response in Fat % reduction to SGLT2 inhibitor therapy in diabetic patients with pretreatment HbA1c levels ≥ 7.7%.