Introduction

Amidst the rising prevalence of Type 2 Diabetes Mellitus (T2DM), a contemporary study published in the Clinical Nutrition ESPEN journal promises hope. The research, led by a distinguished team based at the SRM Medical College Hospital & Research Centre in Tamil Nadu, India, sheds light on the effectiveness of a cutting-edge diabetes treatment—dapagliflozin. The compound, a member of the transformative class of Sodium-glucose cotransporter-2 (SGLT2) inhibitors, not only reduces blood sugar levels but also significantly improves serum and urinary uric acid levels in individuals suffering from T2DM.

DOI: 10.1016/j.clnesp.2023.11.013

Abstract

The study meticulously conducted on 60 T2DM patients, revealed intriguing results post a 3-month regimen of dapagliflozin. Key physiological markers such as body weight, fasting and postprandial blood glucose, Hemoglobin A1C (HbA1c), and serum lipids, among others, were assessed pre and post-treatment. A remarkable decrease in serum uric acid—from 9.0 mg/dL to 8 mg/dL—and an increase in uric acid percentage in urine—from 16.1% to 23.6%—were documented. Furthermore, a decrease in HbA1C levels and an improvement in insulin resistance marked a superior overall glycemic profile in the dapagliflozin group relative to baseline measurements.

Body of the Article

In an era where diabetes management is a global health priority, the innovative treatment modality of SGLT2 inhibitors, specifically dapagliflozin, offers a glimmer of new therapeutic potential. Not only does it contribute to lower blood sugar levels sans insulin, but it also exhibits a compelling interplay with another critical physiological metabolite—uric acid. Elevated uric acid levels are not uncommon in patients with T2DM, being implicated in both the complication and progression of the condition.

Rajasekar R R and his colleagues embarked on a research endeavor to investigate this interrelation, ultimately exploiting it to amplify the therapeutic impact of dapagliflozin—a well-recognized antidiabetic that works by preventing glucose reabsorption in the kidneys, thus lowering blood glucose levels.

Over the span of three months, patients with T2DM were administered a daily dose of 10mg dapagliflozin, with a concise and rigorous assessment of their health parameters at the culmination of the treatment period. The outcomes were measured against a cohort of healthy individuals, ensuring robust comparative analysis.

The data gleaned from this study revealed a multi-faceted improvement in the patients’ health profile. The most striking outcome was the pronounced reduction of serum uric acid levels—a marker often associated with not only metabolic issues but also cardio-renal complications in T2DM patients. This reduction resonates with prior evidence hinting at the reciprocal relationship between SGLT2 inhibitor therapy and serum uric acid concentrations.

An increase in urinary excretion of uric acid further validates dapagliflozin’s role in enhancing renal urate clearance, a benefit that could potentially extend beyond glycemic management to the mitigation of gout—a frequent comorbidity in diabetic populations.

Concordantly, the documented decline in HbA1C levels post-treatment not only substantiates effective glycemic control but also illustrates the potential for long-term positive outcomes, encompassing a reduction in diabetic complications.

It’s crucial to note that the improvement in the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in patients under dapagliflozin treatment underscores another significant achievement. Enhanced insulin sensitivity indicates a stride towards mitigating the insulin resistance that characterizes and exacerbates T2DM.

The multivariate correlation analysis conducted further fortified these findings, displaying a positive correlation of serum uric acid with the glycemic profile. It’s a revelation that could prompt healthcare providers to consider uric acid levels as a marker for therapeutic monitoring in diabetes management.

Implications of the Study

This study cements the position of dapagliflozin as a multifaceted agent in the diabetes therapeutic arsenal. The reduction of serum uric acid levels complemented by improved insulin sensitivity paints a holistic picture of the drug’s capability to enhance the quality of life for those grappling with T2DM. Furthermore, the safe and effective reduction of uric acid may have a protective role vis-à-vis renal function—a common concern in the diabetic demographic.

Healthcare professionals and endocrinologists worldwide can draw insights from the affirmative results of this peer-reviewed study, potentially tailoring their prescription practices to amplify the benefits for patients enduring T2DM.

Conclusion

In closing, the findings of the study authored by Rajasekar R R and his team represent a quantum leap in the therapeutic landscape of Type 2 Diabetes Mellitus. Dapagliflozin emerges not merely as a hypoglycemic agent but as a beacon of comprehensive metabolic correction.

The scientific community and the medical fraternity at large await further investigative studies that may expand on these promising findings. Multi-centered trials and longer follow-up durations are anticipated to further elucidate the role of dapagliflozin in improving diabetic and metabolic health.

Copyright

Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Author Information

1. Rajasekar R R, Department of General Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
2. Sundaram Sivaraj Mohana SM, Division of Medical Research, Faculty of Medical and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, India; Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore, Madhya Pradesh, India.
3. Raj C Poornima CP, Department of General Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
4. Poovitha M M, Department of General Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
5. Kumar Janardanan Subramonia JS, Department of General Medicine, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, India.

References

1. Scheen AJ. SGLT2 inhibitors: benefit/risk balance. Curr Diab Rep. 2016;16(10):92. doi: 10.1007/s11892-016-0783-4.
2. Chino Y, Samukawa Y, Sakai S, et al. SGLT2 inhibitor lowers serum uric acid through alteration of uric acid transport activity in renal tubule by increased glycosuria. Biopharm Drug Dispos. 2014;35(7):391-404. doi: 10.1002/bdd.1897.
3. Lytvyn Y, Škrtić M, Yang GK, et al. Glycosuria-mediated urinary uric acid excretion in patients with uncomplicated type 1 diabetes mellitus. Am J Physiol Renal Physiol. 2015;308(2):F77-F83. doi: 10.1152/ajprenal.00464.2014.
4. Bonner C, Kerr-Conte J, Gmyr V, et al. Inhibition of the glucose transporter SGLT2 with dapagliflozin in pancreatic alpha cells triggers glucagon secretion. Nat Med. 2015;21(5):512-7. doi: 10.1038/nm.3828.
5. Ptaszynska A, Hardy E, Johnsson E, Parikh S, List J. Effects of dapagliflozin on cardiovascular risk factors. Postgrad Med. 2013;125(3):181-9. doi: 10.3810/pgm.2013.05.2675.

Keywords

1. Dapagliflozin Type 2 Diabetes
2. SGLT2 Inhibitors
3. Serum Uric Acid
4. Insulin Resistance
5, Diabetes Glycemic Control