SGLT2 inhibitor plus calorie restriction improves diabetes remission rate

Key takeaways:

• Overall, 44% of the calorie restriction and dapaglifozin treatment group achieved diabetes remission compared with 28% of the placebo group.
• The treatment also reduced more body weight vs. placebo.

Use of a sodium-glucose cotransporter 2, or SGLT2, inhibitor combined with calorie restriction resulted in greater rates of type 2 diabetes remission compared with calorie restriction alone, according to results of a randomized study published in BMJ.

The “practicable and feasible” intervention corresponded with several other positive health benefits, such as a reduction in weight and improved metabolic risk factors, the researchers noted.

The results “are very exciting and expected,” Xiaoying Li, a professor at Fudan University in China, told Healio.

“Diabetes has long been considered as an incurable illness and the patients need to take medication for life. Diabetes complications occur as diabetes progresses,” he said. “Thus, it is important to find a strategy to stop the progression of diabetes for prevention of diabetes complications.”

In the multicenter, double-blind randomized controlled trial, the researchers compared the effects from calorie restriction — a reduction of 500 to 750 calories a day — alongside daily 10 mg dapagliflozin (Farxiga, AstraZeneca) with those from only calorie restriction among 328 patients aged 20 to 70 years with obesity or overweight and type 2 diabetes.

Trial participants had diabetes for less than 6 years, kept a dietary log throughout the study and were encouraged to be physically active by doing 150 minutes of brisk walking every week or taking more than 10,000 steps daily.

Diabetes remission — defined as maintaining normal blood sugar levels for at least 2 months after stopping antidiabetic medication — over 12 months served as the study’s primary outcome measurement. Secondary outcomes included body weight, body fat, waist circumference and BP.

Li and colleagues found that 44% of the dapagliflozin group achieved remission vs. 28% of the placebo group (RR = 1.56, 95% CI, 1.17-2.09).

The dapagliflozin group also showed greater changes in body weight (difference = 1.3 kg; 95% CI 1.9 to 0.7) and insulin resistance (difference = 0.8; 95% CI, 1.1 to 0.4) compared with the placebo group.

Furthermore, systolic BP, body fat, HbA1c, fasting plasma glucose and serum triglycerides were all substantially more improved in the dapagliflozin group vs. the placebo group.

Both groups had improvements in factors including waist circumference, diastolic BP and total cholesterol, although no significant differences in adverse events were seen between the two.

The researchers noted some study limitations. For example, the findings may not be generally applicable to diverse populations or those who have had diabetes for over 6 years.

Still, the results “provide an alternative and more practical strategy than intensive weight management to achieve remission for patients with early type 2 diabetes,” Li and colleagues concluded.

“The risk factors for diabetes remission and the mechanism of remission will be investigated in the future,” Li told Healio.

References:

• SGLT-2 drug plus moderate calorie restriction achieves higher diabetes remission. Available at: https://www.eurekalert.org/news-releases/1071123. Published Jan. 22, 2025. Accessed Feb. 4, 2025.
• Liu Y, et al. BMJ. 2025;doi:10.1136/ bmj-2024-081820.