Effects of a sodium glucose co-transporter2 selective inhibitor, ipragliflozin, on the diurnal profile of plasma glucose in patients with type2 diabetes: A study using continuous glucose monitoring

Aims/IntroductionTo assess the effects of sodium glucose co-transporter2 inhibitor therapy on the pathophysiology of type2 diabetes. Materials and MethodsWe administered ipragliflozin to 21 inpatients with type2 diabetes for 7days, and analyzed the diurnal profiles of plasma glucose and 3-hydroxybutyrate. A total of 21 age-, sex- and body mass index-matched diabetic patients served as controls. ResultsContinuous glucose monitoring showed that the 24-h glucose curve was shifted downward without hypoglycemia by the administration of ipragliflozin. The average glucose level was reduced from 18254mg/dL to 141 +/- 33mg/dL (P<0.0001). The magnitude of the reduction was highly correlated with the baseline average glucose level. Homeostasis model assessment of insulin resistance was decreased, and homeostasis model assessment of -cell function was increased during the treatment. Urinary glucose excretion was correlated with the average glucose level both on day0 and on day7, although the regression line was steeper and shifted leftward on day7. The ipragliflozin-treated patients lost more weight than the control patients (1.4 +/- 0.5 vs 0.5 +/- 0.6kg, P<0.0001). Plasma levels of 3-hydroxybutyrate were significantly increased with peaks before breakfast and before dinner. Patient age and bodyweight loss were negatively and positively correlated with the peak levels of 3-hydroxybutyrate on day7, respectively. ConclusionsThe ipragliflozin treatment improved the 24-h glucose curve without causing hypoglycemia. The close correlation between the magnitude of glucose reduction and the baseline plasma glucose concentration suggests that the risk of hypoglycemia is likely low. It might be prudent to monitor ketone body levels in younger patients and in patients with rapid weight loss.