Comparison of Serum Ketone Levels and Cardiometabolic Efficacy of Dapagliflozin versus Sitagliptin among Insulin-Treated Chinese Patients with Type 2 Diabetes Mellitus

Chi-Ho Lee; Mei-Zhen Wu; David Tak-Wai Lui; Darren Shing-Hei Chan; Carol Ho-Yi Fong; Sammy Wing-Ming Shiu; Ying Wong; Alan Chun-Hong Lee; Joanne King-Yan Lam; Yu-Cho Woo; Karen Siu-Ling Lam; Kelvin Kai-Hang Yiu; Kathryn Choon-Beng Tan

doi:10.4093/dmj.2021.0319

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자료유형: 학술저널

저자정보: Chi-Ho Lee (University of Hong Kong) Mei-Zhen Wu (University of Hong Kong) David Tak-Wai Lui (University of Hong Kong) Darren Shing-Hei Chan (University of Hong Kong) Carol Ho-Yi Fong (University of Hong Kong) Sammy Wing-Ming Shiu (University of Hong Kong) Ying Wong (University of Hong Kong) Alan Chun-Hong Lee (University of Hong Kong) Joanne King-Yan Lam (University of Hong Kong) Yu-Cho Woo (University of Hong Kong) Karen Siu-Ling Lam (University of Hong Kong) Kelvin Kai-Hang Yiu (University of Hong Kong) Kathryn Choon-Beng Tan (University of Hong Kong)

저널정보: 대한당뇨병학회 Diabetes and Metabolism Journal Diabetes and Metabolism Journal Vol.46 No.6

발행연도: 2022.11

수록면: 843 - 854 (12page)

DOI: 10.4093/dmj.2021.0319

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Background: Insulin-treated patients with long duration of type 2 diabetes mellitus (T2DM) are at increased risk of ketoacidosis related to sodium-glucose co-transporter 2 inhibitor (SGLT2i). The extent of circulating ketone elevation in these patients remains unknown. We conducted this study to compare the serum ketone response between dapagliflozin, an SGLT2i, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, among insulin-treated T2DM patients.Methods: This was a randomized, open-label, active comparator-controlled study involving 60 insulin-treated T2DM patients. Participants were randomized 1:1 for 24-week of dapagliflozin 10 mg daily or sitagliptin 100 mg daily. Serum β-hydroxybutyrate (BHB) levels were measured at baseline, 12 and 24 weeks after intervention. Comprehensive cardiometabolic assessments were performed with measurements of high-density lipoprotein cholesterol (HDL-C) cholesterol efflux capacity (CEC), vibration-controlled transient elastography and echocardiography.Results: Among these 60 insulin-treated participants (mean age 58.8 years, diabetes duration 18.2 years, glycosylated hemoglobin 8.87%), as compared with sitagliptin, serum BHB levels increased significantly after 24 weeks of dapagliflozin (P=0.045), with a median of 27% increase from baseline. Change in serum BHB levels correlated significantly with change in free fatty acid levels. Despite similar glucose lowering, dapagliflozin led to significant improvements in body weight (P=0.006), waist circumference (P=0.028), HDL-C (P=0.041), CEC (P=0.045), controlled attenuation parameter (P=0.007), and liver stiffness (P=0.022). Average E/e’, an echocardiographic index of left ventricular diastolic dysfunction, was also significantly lower at 24 weeks in participants treated with dapagliflozin (P=0.037).Conclusion: Among insulin-treated T2DM patients with long diabetes duration, compared to sitagliptin, dapagliflozin modestly increased ketone levels and was associated with cardiometabolic benefits.

#Dapagliflozin #Diabetes mellitus #type 2 #Heart disease risk factors #Ketones #Sitagliptin phosphate

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