Comparison of the Impact of SGLT2-Inhibitors and Exenatide on Body Fat Composition.

Objective: To investigate the effect of SGLT2-i and GLP-1RA as an add-on therapy to metformin on weight loss and body composition, and to compare their effects on glucose and lipid parameters.

Study Design: A descriptive study. Place and Duration of the Study: Goztepe Prof Dr Suleyman Yalcin City Hospital, from January 2016 to May 2021.

Methodology:  The study included 50 patients with diabetes on metformin+SGLT2-i (dapagliflozin or empagliflozin, group 1) and 50 patients with diabetes on metformin+GLP-1 receptor agonist (RA, exenatide, group 2).

Results: The reduction in weight, BMI, total body, abdominal, leg, and arm fat percentage, and the improvement in body fat-free and muscle mass percentage were significantly higher in Group 2 (p<0.001, p<0.001, p=0.014; p=0.031, p<0.001; p=0.002 and p=0.014, p=0.014, respectively). The decline in abdominal fat mass in the GLP-1 RA group was also significant (p=0.031). There was a significant decrease in HbA1c, fasting glucose, and triglyceride levels (p<0.001, p<0.001, and p=0.036) with a significant increase in HDL-C (p=0.015). There was no significant difference between groups for glucose, HbA1c, and lipid parameters (p>0.05).

Conclusion: Both SGLT2 inhibitors and exenatide, when added to metformin therapy, were effective in reducing weight and body fat, more by the GLP-agonist. SGLT2-i had no significant impact on decreasing abdominal fat depicting that these agents do not have any benefit in treating visceral adiposity.

Key Words: Type 2 diabetes mellitus, Obesity, GLP-1 receptor, SGLT2 inhibitor, Body fat distribution, Visceral adiposity.