| Background:Due to the positive effects of Sodium-glucose cotransporter-2(sodium-glucose cotransporter-2,SGLT-2)inhibitors in glucose reduction,weight reduction,cardiac and renal protection,its clinical application has been greatly expanded.However,findings are not entirely consistent regarding the effects of SGLT-2 inhibitors on body composition and whether they increase the risk of sarcopenia,osteoporosis,and even fractures in patients with type 2 diabetes.Objective:The purpose of this study is to examine the effects of SGLT-2 inhibitors on body composition in patients with type 2 diabetes and provide a basis for the clinical application of this drug.Methods:According to the inclusion and exclusion criteria,all research literature regarding the effects of SGLT-2 inhibitors on body composition in patients with type 2 diabetes mellitus included in the National Library of Medicine database(PubMed),Cochrane Library(Cochrane Library),and Excerpta Medica Database(Embase)from the date of creation to October 17,2022 were selected.Meta-analysis was performed by Review Manager5.3,StataSE14and StataSE16 software,and using Mean Difference(MD)as an effect indicator to examine the effects of SGLT-2 inhibitors on body weight,adiposity,fat percentage,visceral fat,subcutaneous fat,lean body mass,body water,intracellular water,extracellular water,muscle mass,protein mass,mineral mass.Results:1.Basic characteristics of the included literatures:After literature screening,31 original papers were included in this study,with a total sample size of 2787 cases.Among them,10 were RCT studies,4 were non-randomized controlled studies,and 17 were single-arm studies.2 were international multicenter randomized controlled studies,2 were non-randomized controlled studies conducted in the European region,and the remaining studies were in the Asian region,mainly in Japan.the SGLT-2 inhibitor drug types included SGLT-2 inhibitors in 2 cases,Tofogliflozin in 4 cases,Luseogliflozin in 4 cases,Ipragliflozin in 6 cases,and 6 cases of Canagliflozin,6 cases of Dapagliflozin,and 3 cases of Empagliflozin.2.Effect on body weight:Patients with type 2 diabetes mellitus who applied SGLT-2 inhibitors had a significant weight loss with a WMD of-2.69,95%confidence interval[CI]of(-3.37,-2.01),P=0.000<0.05.The WMD was-1.61(P=0.006<0.05),-2.44(P=0.006<0.05),-3.32(P=0.000<0.05)for the three time periods of 4-8 weeks,12-24 weeks,and≥1 year,respectively.3.Effects on fat:1)Effect on adiposity:Clinical application of SGLT-2 inhibitors significantly reduced adiposity in patients with type 2 diabetes with a combined WMD of-1.28,95%confidence interval[CI]of(-1.65,-0.90),P=0.000<0.05.At 4-8 weeks,12-24 weeks,and≥1 year,the WMD of change in adiposity was-1.16(P=0.001<0.05),-1.28(P=0.000<0.05),-2.58(P=0.008<0.05).2)Effect on fat percentage:Application of SGLT-2 inhibitors treatment resulted in a 0.75%decrease in fat percentage of body composition with 95%confidence interval[CI]of(-1.13,-0.37),P=0.000<0.05.at 4 weeks,12 weeks,24 weeks,and 1 year,the WMD was-0.53(p=0.248>0.05),-1.01(P=0.017<0.05),-0.69(P=0.001<0.05),-2.21(P=0.005<0.05).3)Effect on subcutaneous fat:SGLT-2 inhibitors resulted in a significant reduction in subcutaneous fat area in T2DM patients with a WMD of-20.72,95%confidence interval[CI]of(-37.96,-3.48),P=0.019<0.05.At 12,16 and 24 weeks,the WMD was-15.98(P=0.164>0.05),-16.72(P=0.397>0.05),-21.71(P=0.027<0.05).4)Effect on visceral fat:Application of SGLT-2 inhibitors caused a reduction in visceral fat area with a WMD of-8.42,95%confidence interval[CI]of(-11.75,-5.10),P=0.000<0.05.At 4-8 weeks,12-16 weeks,and 24 weeks,the WMD was-5.69(P=0.003<0.05),-7.50(P=0.000<0.05),-13.46(P=0.001<0.05).4.Effect on other body compositions but fat mass:1)Effect on lean body mass:SGLT-2 inhibitors caused a reduction in lean body mass in type 2 diabetic patients with a WMD of-0.84,95%confidence interval[CI]of(-1.35,-0.33),P=0.001<0.05.At 4 weeks,12 weeks,24 weeks,and 1 year,the WMD was-0.84(P=0.028<0.05),-0.92(P=0.01<0.05),-0.71(P=0.042<0.05),and-0.90(P=0.346>0.05).2)Effect on muscle mass:SGLT2 inhibitors did not affect muscle mass in patients with T2DM,with a combined WMD of-0.54,95%[CI](-1.70,0.62),P=0.363>0.05.At 4,12,and 24 weeks,the WMD was-0.35(P=0.599>0.05),-0.54(P=0.398>0.05),-0.51(P=0.398>0.05).3)Effect on body water:Application of SGLT-2 inhibitors treatment resulted in a reduction in total body water in T2DM patients with a WMD of-0.75,95%confidence interval[CI]of(-1.24,-0.25),P=0.003<0.05.At 4-8 weeks,12 weeks,24 weeks,and 1 year,the WMD was-0.67(P=0.013<0.05),-0.78(P=0.004<0.05),-0.50(P=0.245>0.05),-0.39(P=0.705>0.05).4)Effect on extracellular water:SGLT-2 inhibitors affected extracellular water in patients with type 2 diabetes with a combined WMD of-0.328,95%confidence interval[CI]of(-0.52,-0.14),P=0.001<0.05.At 4 weeks,12 weeks,24 weeks,and 1 year,the WMD was-0.30(P=0.03<0.05),-0.33(P=0.01<0.05),-0.39(P=0.037<0.05),-0.52(P=0.173>0.05).5)Effect on intracellular water:SGLT-2 inhibitors reduced intracellular water in T2DM patients with a combined WMD of-0.361,95%[CI]of(-0.69,-0.03),P=0.034<0.05.At 4 weeks,12 weeks,24 weeks,and 1 year,the WMD was-0.35(P=0.049<0.05),-0.34(P=0.052>0.05),-0.10(P=0.744>0.05),and 0.13(P=0.857>0.05).6)Effect on protein:SGLT-2 inhibitors did not affect protein mass in T2DM patients with a combined WMD of-0.02,95%[Cl](-0.28,0.24),P=0.860>0.05.At 4-8 weeks,12-16 weeks,and 24 weeks,the WMD was-0.00(P=0.997>0.05),-0.02(P=0.883>0.05),-0.02(P=0.889>0.05).7)Effect on minerals:SGLT-2 inhibitors did not affect the mineral mass of T2DM patients with a combined WMD of-0.10,95%confidence interval[CI]of(-0.21,0.01),P=0.085>0.05.At 4-8 weeks,12-16 weeks,and 24 weeks,the WMD was-0.01(P=0.868>0.05),-0.09(P=0.109>0.05),-0.11(P=0.068>0.05).Conclusions:1.SGLT-2 inhibitors significantly reduced body weight in patients with type 2 diabetes.2.SGLT-2 inhibitors significantly reduced adiposity and lean body mass in patients with T2DM,but the former was reduced more.3.SGLT-2 inhibitors affected both visceral fat and subcutaneous fat in type 2 diabetic patients,but the reduction in subcutaneous fat area was greater.4.SGLT-2 inhibitors caused a decrease in lean body mass in T2DM patients,which was mainly attributed to the decrease in body water,while there was little effect on muscle mass,protein content,and mineral content in T2DM patients.5.The effect of SGLT-2 inhibitors on body water is dominated by the reduction of extracellular water in the early stages. |
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