Abstract
BackgroundThe current study was to evaluate the effects of canagliflozin and metformin on insulin resistance and visceral adipose tissue in people with newly-diagnosed type 2 diabetes.MethodsThis is an open-label, parallel and controlled study. Participants were divided into canagliflozin (100 mg/qd) or metformin (1000 mg/bid) groups. At baseline and after 12 weeks’ therapy, insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)], subcutaneous and visceral adipose tissue, fasting blood glucose (FBG), glycated hemoglobin A1c (HbA1c), C-reactive protein (CRP) and nitric oxide (NO) were evaluated and compared.ResultsThere was no significant between-group difference in baseline characteristics. After 12 weeks’ therapy, in canagliflozin group (n = 67), compared to baseline, FBG, HbA1c and HOMA-IR were decreased, accompanying with reduction of visceral adipose tissue. Compared to metformin group (n = 73), FBG, HbA1c and HOMA-IR were lower in canagliflozin group, accompanying with less visceral adipose tissue and lower serum CRP level and higher NO level. After multivariable regression analysis, age, visceral adipose tissue and CRP remained associated with increased insulin resistance, while canagliflozin treatment and higher NO level were associated with reduced insulin resistance. Body mass index, waist/hip ratio, CRP and HOMA-IR remained associated with increased visceral adipose tissue, while canagliflozin treatment and higher NO level were associated with reduced visceral adipose tissue. There was no difference in adverse event between these two groups.ConclusionCanagliflozin reduces visceral adipose tissue and improves blood glucose, insulin resistance and systemic inflammation in people with newly-diagnosed type 2 diabetes.
Highlights
The current study was to evaluate the effects of canagliflozin and metformin on insulin resistance and visceral adipose tissue in people with newly-diagnosed type 2 diabetes
Prior studies have shown that compared to subcutaneous adipose tissue, visceral adipose tissue is more relevant to metabolic disorder, chronic inflammation and insulin resistance [15,16,17,18]
Age, visceral adipose tissue, and C-reactive protein (CRP) remained associated with increased insulin resistance, while canagliflozin treatment and higher serum nitric oxide (NO) level was associated with reduced insulin resistance
Summary
The current study was to evaluate the effects of canagliflozin and metformin on insulin resistance and visceral adipose tissue in people with newly-diagnosed type 2 diabetes. Among people with newly-diagnosed type 2 diabetes, results of our prior study indicated that 12 weeks’ dapagliflozin therapy was associated with significant improvement in insulin resistance and blood glucose, which might be partly attributed to the amelioration of systemic inflammation [10]. Whether the benefit of SGLT2i on improving insulin resistance and blood glucose is related to the reduction of abdominal adipose tissue is unknown. Our prior study suggested that compared to baseline, the waist/ hip ratio, a marker of abdominal obesity, was reduced after 12 weeks’ dapagliflozin therapy [10]. It was unknown whether the reduction of waist/hip ratio was due to decrease in subcutaneous or visceral adipose tissue. There are racial/ethnic-differences in body composition as well as lifestyle and dietary pattern [21,22,23,24,25], and it is needed to evaluate the association between SGLT2i therapy and visceral adipose tissue changes in China’s populations with diabetes, given the high consumption of high-carbohydrate food in China
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