Endocrine Abstracts

Background: Response to therapy with glucose-lowering agents, in terms of glycemic control and weight loss, presents significant interindividual variability. This study investigated the association between clinical and laboratory parameters and response to therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM).

Methods: We retrospectively analyzed the medical records of people with T2DM in whom SGLT2i was started, without the concomitant initiation of any other pharmaceutical agent. Clinical and laboratory parameters were recorded before, at 3 and 6 months after starting treatment. We defined a good response in terms of glycemic control, as meeting one of the following criteria, at 3 or 6 months: i. Glycated hemoglobin (HbA1c) <7% ii. Reduction in HbA1c ≥1% compared to baseline iii. Maintaining HbA1c <7% that a patient had before starting SGLT2i. A good response in terms of weight loss was defined as losing ≥3% of the baseline weight at 3 or 6 months.

Results: We included 50 individuals (64% men) with a mean age of 65.8 ± 8.5 years. 86% and 64% of the participants were classified into good response categories for glycemic control and weight loss, respectively. Good responders in terms of glycemia had lower high-density lipoprotein cholesterol levels at baseline compared to bad responders (43.3 vs 57.4 mg/dl, P=0.044). Both the good and bad responders in terms of weight loss experienced a significant reduction in HbA1c levels between baseline and 3 months (-0.6%, P=0.002 and -0.8%, P=0.003, respectively). Only good responders in terms of glycemic control and weight loss experienced a significant improvement in the estimated glomerular filtration rate values at 3 months compared to baseline (+2.9 ml/min/1.73 m², P=0.015 and +3.68 ml/min/1.73 m², P=0.006, respectively). In logistic regression analysis, a higher baseline weight was associated with a better response to therapy in terms of weight loss (P=0.04).

Conclusions: Specific clinical and laboratory parameters are associated with response to SGLT2i treatment. Responses in terms of glycemic control and weight loss appear to be two distinct outcomes, despite the common underlying mechanism. These findings can contribute to a more personalized approach to T2DM care.