ABSTRACT
Background: There are a handful of sodium glucose co-transporter 2 (SGLT2) inhibitors available in the global and Indian markets to manage type II diabetes mellitus (T2DM). However, head-to-head comparison between different SGLT2 inhibitors is scarce. Therefore, the present study was aimed to analyze the effect of different SGLT2 inhibitors on glycemic control and body weight in Indian patients with T2DM. Methods: This was a prospective, interventional, nonrandomized study that included patients (N = 480) of either sex, aged ?30 years, with inadequately controlled T2DM having HbA1c > 8.5%, and were receiving either Canagliflozin, Empagliflozin, Dapagliflozin or Remogliflozin on the background of triple-drug therapy. In this study, patients were evaluated for HbA1c, fasting blood sugar (FBS), post-prandial blood sugar (PPBS), body weight, and systolic and diastolic blood pressure at baseline, 12 and 24 weeks. Results: A total of 480 patients who received either Canagliflozin (n = 120), Empagliflozin (n = 120), Dapagliflozin (n = 120), or Remogliflozin (n = 120) were included in this study. There was a significant reduction in levels of HbA1c, FBS, PPBS, body weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at week 12 and 24 in all treatment groups. The difference in mean values of glycemic parameters and body weight was comparable across the treatment groups at week 12 and 24 but was not significant. Out of all 480 patients, 10 patients (2.08%) reported urinary tract infection (UTI), and five (1.04%) reported genital mycotic infection. All the five patients were females and treatment for UTI and mycotic infection was provided as required. Rest of the patients tolerated the therapy well. Conclusion: Overall observations indicate that all the four SGLT2 inhibitors are effective in reducing HbA1c, FBS, PPBS, body weight SBP, and DBP. Therefore, gliflozins can be the best choice to start early in patients with inadequately controlled T2DM receiving triple-drug therapy which helps in controlling the parameters of glycemia and significantly reducing the body weight. Hence SGLT2 Inhibitors could be considered as an add-on to all antidiabetic agents currently used for the management of diabetes in Indian setting.
ABSTRACT
Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with deranged fat, carbohydrate and protein metabolism that results from improper secretion or action of insulin. The precursor state to diabetes mellitus is called as Prediabetes in which not all symptoms of diabetes are present but the blood sugar is abnormally high. Dyslipidemia which as often as possible happens in diabetes play out an imperative job in quickening of macrovascular difficulty and add to expand danger of cardiovascular ailment. We conducted this study to assess the role of lipid profile in prediabetics, compared between group of asymptomatic diabetes and healthy controls. Methods: This was a hospital based cross sectional case control study in which 89 individuals with established diagnosis of Prediabetics were included on the basis of a predefined inclusion and exclusion criteria.89 healthy aged matched individuals were enrolled in the control group. A detailed personal, family and past history was taken in all the cases and a thorough clinical examination was done. Family history of diabetes and hypertension was particularly asked and noted down. Demographic details such as age, sex and socioeconomic status was noted in all the cases. Weight and BMI was analyzed. Diagnosis of prediabetes was done on the basis of ADA criteria. Lipid Profile were carried out under the guidance of physician for all cases and data was recorded for evaluation. Statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Out of a total 178 patients there were 96 males and 82 females with an M: F ratio of 1:0.854. The mean age of patients in group 1 and 2 was 50.92 ± 12.42 and 50.30 ± 12.64 respectively. The mean BMI of subjects in Group 1 was 25.58 ± 3.25kg/m2 and 25.80 ± 3.43 kg/m2 respectively. The mean age and BMI of the patients was found to be comparable in both the groups. The mean systolic and diastolic blood pressure values were found to be comparable in both the groups with no statistically significant difference (P>0.05). The FBS and PPBS values of subjects in Group 1 were significantly lesser (93.77±15.47mg/dl and 121.79±11.29mg/dl) as compared to FBS and PPBS values of subjects in Group 2 (112.52±16.40mg/dl and 177.23±17.31mg/dl). This difference was statistically significant as per Student t-test (p<0.05). The Glycosylated Hemoglobin (HbA1c) values of subjects in Group 1 (5.27±0.25%) were significantly lesser as compared to HbA1c values of subjects in Group 2 (6.14±0.34%). Total cholesterol, Triglycerides, LDL, HDL, VLDL, TG/HDL and LDL/HDL ratio were found to be statistically significantly different in both the groups (P<0.05). Conclusion: Lipid profile in prediabetic subjects containing Total cholesterol, TG, TG/HDL ratio and LDL/HDL ratio are remarkably raised compared to normal healthy subjects and HDL cholesterol is lower than normal subjects. These finding underlines the need for detection of prediabetics so that appropriate interventions can be done.