Visual Abstract

SGLT2is are known to lower weight along with glycemic control, but few studies have simultaneously examined changes in EI and PA in relation to changes in weight and HbA1c after lengthy drug use. No reports have compared results between SGLT2is and DPP4is. We conducted a post-hoc analysis of a 52-week randomized controlled trial of Ipr and Sit in 87 participants (44 with Ipr, 43 with Sit, 58.7 y, 58.6% male, HbA1c 7.53%, BMI 26.7 kg/m2, EI 1817 kcal and PA 11.6 METs h/w). EI (+183.8 vs. -6.0, p=0.02) and PA (+1.63 vs. -1.65, p=0.02) were significantly greater with Ipr than with Sit, but HbA1c changes were not statistically different between Ipr and Sit (-0.51 vs. -0.46, p=0.63). Changes in HbA1c with Sit did not differ regardless of whether EI was increased (-0.39 vs. 0.52, p=0.76). Conversely with Ipr the improvement in HbA1c was attenuated in those with increased EI vs. decreased EI (-0.41 vs. -0.70, p=0.08). Changes in HbA1c did not differ regardless of changes in PA with Ipr (-0.42 vs. -0.62, p=0.29) and Sit (-0.54 vs. -0.43, p=0.41). Changes in EI and PA had little impact on BMI. Both SGLT2i and DPP4i improved HbA1c despite increasing EI, but glycemic control was attenuated with SGLT2i compared with DPP4i in those with increased EI. These results suggested the importance of avoiding increases in EI at least when taking SGLT2 inhibitors.


M. Kitazawa: None. M. H. Yamada: None. M. Iwanaga: None. M. Yamamoto: None. M. Hatta: None. T. Yamada: None. K. Fujihara: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.


Astellas Pharma Inc.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at