Effects Of The Sglt2 Inhibitor Dapagliflozin On Epicardial And Visceral Fat In Patients With Type 2 Diabetes And Metabolic Syndrome: A Randomized Controlled Trial

Introduction: A recent randomized, placebo-controlled trial in patients with type 2 diabetes with high cardiovascular risk demonstrated that the Sodium-glucose co-transporter-2 inhibitors (SGLT2i), empagliflozin, reduced the rate of the primary composite cardiovascular outcome and of death from any cause. SGLT2i reduce glucose levels, body weight, and blood pressure, possibly resulting in cardiovascular protection. While, epicardial fat is associated with fatal and nonfatal coronary events independent of traditional cardiovascular risk factors. However, the effects of the SGLT2i on epicardial and visceral fat are not clear. Hypothesis: We aimed to evaluate whether dapagliflozin, another SGLT2i, affects epicardial and visceral fat assessed by computed tomography (CT) in patients with type 2 diabetes and metabolic syndrome in a randomized controlled trial. Methods: Sixty-seven type 2 diabetic patients with metabolic syndrome were randomized to receive dapagliflozin 10 mg or only nutrition education (= control) for 12 weeks on top of their glucose lowering medications. The primary endpoint was the change in epicardial and visceral fat assessed by CT at study end versus baseline. The key secondary endpoints after 12 weeks of treatment are the change from baseline in glycemic control, blood pressure, body weight, lipid profile, renal function and uric acid. Results: Sixty-six patients completed the study, n = 34 in the control group and n = 32 in the dapagliflozin group. There were no differences in baseline characteristics between two groups. Therapy with dapagliflozin reduced HbA1c by 0.5 %, body weight by 1.8 kg, systolic blood pressure by 6.6 mmHg and uric acid by 0.5 mg/dL. As compared to control, dapagliflozin reduced the area of visceral fat measured by CT (–11 ± 5 versus –3 ± 3 cm 2 ; p Conclusions: Despite improvements in metabolic disorders and reduction in visceral fat, therapy with dapagliflozin exerted no significant effect on epicardial fat measured by CT. These results suggested that the fat reduction effect of dapagliflozin may be different between visceral fat and pericardial fat.