Switching from low‐dose thiazide diuretics to sodium–glucose cotransporter 2 inhibitor improves various metabolic parameters without affecting blood pressure in patients with type 2 diabetes and hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes mellitus and hypertension (n=50). Intervention: Switching from thiazide diuretics to ipragliflozin vs. Continued thiazide diuretics without switching (non-switching control group, n=19) or pre-switch baseline. Primary outcome: Change in systolic blood pressure at 3 months (p=NS).

Q: What does this research mean for the field?

Switching from thiazide diuretics to the SGLT2 inhibitor ipragliflozin maintains blood pressure control while significantly improving glycemic control, uric acid levels, and body composition in patients with type 2 diabetes and hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tomohiko Kimura; Junpei Sanada; Masashi Shimoda; Hidenori Hirukawa; Yoshiro Fushimi; Momoyo Nishioka; Tomoe Kinoshita; Seizo Okauchi; Atsushi Obata; Kenji Kohara; Fuminori Tatsumi; Shinji Kamei; Shuhei Nakanishi; Tomoatsu Mune; Kohei Kaku; Hideaki Kaneto

doi:10.1111/jdi.12774

November 7, 2017Journal of Diabetes InvestigationOpen Access

Switching from low‐dose thiazide diuretics to sodium–glucose cotransporter 2 inhibitor improves various metabolic parameters without affecting blood pressure in patients with type 2 diabetes and hypertension

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Key result

Switching from thiazides to ipragliflozin maintains blood pressure while lowering HbA1c by ~0.4 percentage points.

P NS
n=50

Why the study?

Does switching from low-dose thiazide diuretics to the SGLT2 inhibitor ipragliflozin improve metabolic parameters and body composition without worsening blood pressure control in patients with type 2 diabetes and hypertension?

Key Points

To compare the effects of switching from a thiazide diuretic to an SGLT2 inhibitor on blood pressure, metabolic parameters, and body composition in patients with type 2 diabetes and hypertension.
Enrolled 31 participants with type 2 diabetes and hypertension whose blood pressure was controlled using thiazide diuretics.
Switched participants from thiazide diuretics to the SGLT2 inhibitor ipragliflozin and evaluated outcomes 3 months after the switch.
Systolic blood pressure changed from 131.2 ± 12.9 mmHg to 132.1 ± 13.2 mmHg and diastolic blood pressure from 74.5 ± 9.9 mmHg to 75.8 ± 11.2 mmHg, showing no significant difference 3 months after the switch.
Glycated hemoglobin decreased from 7.1 ± 1.0% to 6.7 ± 0.9% (P < 0.0001), fasting plasma glucose decreased from 141.2 ± 42.8 mg/dL to 118.9 ± 26.5 mg/dL (P < 0.005), and uric acid decreased from 6.0 ± 1.3 mg/dL to 5.0 ± 1.1 mg/dL (P < 0.0001).
Visceral fat area was reduced from 121.1 ± 51.4 cm2 to 115.5 ± 49.6 cm2 (P < 0.005) and urinary albumin excretion fell from 165.2 ± 335.5 mg/gCr to 108.8 ± 190.4 mg/gCr (P < 0.05).

Study Design

Type

Cohort (n=50)

Multicenter

No

Structured PICO

Does switching from low-dose thiazide diuretics to the SGLT2 inhibitor ipragliflozin improve metabolic parameters and body composition without worsening blood pressure control in patients with type 2 diabetes and hypertension?

P

Population

50 Japanese outpatients (31 switched to ipragliflozin, 19 non-switching controls; mean age 68.9 years, 29% female in switching group) with type 2 diabetes (HbA1c >6.0%) and hypertension controlled on thiazide diuretics plus ARB/ACEi and/or CCB, followed retrospectively for 3 months.

E

Exposure

Switching from low-dose thiazide diuretics to ipragliflozin 50 mg daily for 3 months, while maintaining background antihypertensive (ARB 96.8%, CCB 71.0%) and antidiabetic medications unchanged.

C

Comparator

Continuation of low-dose thiazide diuretics without switching to an SGLT2 inhibitor (n=19 season-matched controls with unchanged medication dosages over the same 3-month observation period), as well as pre-switch baseline comparison.

O

Outcome

Changes in systolic and diastolic blood pressure, metabolic parameters (HbA1c, fasting plasma glucose, fasting insulin, lipid profile, uric acid, urinary albumin excretion), and body mass composition (BMI, body fat mass, visceral fat area, skeletal muscle mass) at 3 months after switching.surrogate

Main Result

Absolute Event Rate: 0.9% vs -2.1%

p-value: p=NS

Replacing low-dose thiazide diuretics with an SGLT2 inhibitor (ipragliflozin) in patients with type 2 diabetes and hypertension maintains blood pressure control while reversing thiazide-associated metabolic abnormalities, reducing visceral adiposity, and lowering albuminuria.

Limitations

Small study population (31 participants in switching group, 19 in control group)
Retrospective study design without a randomized prospective control group
Potential seasonal fluctuation influencing BMI and bodyweight due to winter-to-spring observation period
Small sample size (31 switching participants and 19 non-switching controls)
Retrospective study design lacking a prospective randomized control group
Potential seasonal variation affecting BMI and bodyweight changes from winter to spring

Implication

Metabolic gains without BP worsening support RCTs; should not yet change practice.

Abstract

AIMS/INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors function to increase urinary glucose excretion and improve glycemic control in individuals with type 2 diabetes mellitus. SGLT2 inhibitors, as well as diuretics, increase urinary volume, which leads to the reduction of blood pressure. The aim of the present study was to compare the effects of SGLT2 inhibitor and thiazide diuretic on blood pressure, metabolic parameters and body mass composition. MATERIALS AND METHODS: A total of 31 participants were enrolled in the present study. We switched from thiazide diuretics to an SGLT2 inhibitor, ipragliflozin, in participants with type 2 diabetes and hypertension whose blood pressure was controlled with thiazide diuretics. Three months after the switch, we evaluated the effects of such switching on blood pressure, various metabolic parameters and body mass composition. RESULTS: There was no significant difference in blood pressure from baseline to 3 months later. However, glycated hemoglobin, fasting plasma glucose and uric acid were significantly decreased after the switch. Body mass index and visceral fat area were also significantly reduced after the switch. Furthermore, urinary albumin excretion was also significantly decreased after the switch. CONCLUSIONS: Switching from thiazide diuretic to an SGLT2 inhibitor, ipragliflozin, markedly improved various metabolic parameters and body mass composition without affecting blood pressure in participants with type 2 diabetes and hypertension.

Discussion

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Cite This Study

Kimura et al. (2017) conducted a cohort in Type 2 diabetes mellitus and hypertension (n=50). Switching from thiazide diuretics to ipragliflozin vs. Continued thiazide diuretics without switching (non-switching control group, n=19) or pre-switch baseline was evaluated on Change in systolic blood pressure at 3 months (p=NS). Switching from thiazide diuretics to ipragliflozin 50 mg maintained blood pressure (SBP 131.2 to 132.1 mmHg, P=NS) while significantly reducing HbA1c (7.1% to 6.7%, P<0.0001) and uric acid at 3 months.

synapsesocial.com/papers/6a74b958a85270f303090aea https://doi.org/10.1111/jdi.12774

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Switching from low‐dose thiazide diuretics to sodium–glucose cotransporter 2 inhibitor improves various metabolic parameters without affecting blood pressure in patients with type 2 diabetes and hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Switching from low‐dose thiazide diuretics to sodium–glucose cotransporter 2 inhibitor improves various metabolic parameters without affecting blood pressure in patients with type 2 diabetes and hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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