Prospective Assessment of Body Composition Changes with Sodium Glucose Transporters 2 (SGLT2) Inhibitors in Type 2 Diabetes Mellitus Using Bioelectrical Impedance Analysis

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INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) very often leads to adverse changes in body composition, including increased fat mass and sarcopenic obesity. Sodium-Glucose Co- Transporter 2 inhibitors are effective hypoglycaemic medications that also promote weight loss, but their specific impact on body composition remains unclear, particularly in Indian populations. Hence, this study intended to determine the extent of alterations in body composition parameters in T2DM patients on SGLT 2 inhibitor therapy using Bioelectrical Impedance Analysis (BIA). METHODS: This prospective observational study enrolled 60 adults with T2DM initiated on SGLT2 inhibitors along with standard therapy. BIA measurements were taken at baseline, 30 days, and 90 days. Parameters included Body Weight (BW), Body Mass Index (BMI), Skeletal Muscle Mass (SMM), Body Fat Mass (BFM), visceral fat percent, and ECW/TBW. Data from 55 patients were analysed. Descriptive statistics were calculated at baseline, 30 days, and 90 days and expressed as mean ± SD. The data were compared by means of repeated measures ANOVA. RESULTS: No significant changes in body composition were observed at 30 days. After 90 days, a statistically significant (p < 0.05) decrease in BW (73.4 ± 10.1 vs 70.4 ± 7.5), BMI (28.5 ± 3.0 vs 27.4 ± 2.6), BFM (30.7 ± 7.3 vs 28.6 ± 5.7), and visceral fat% (13.8 ± 4.4 vs 12.4 ± 3.0) was observed. SMM and ECW/TBW ratio remained unchanged. DISCUSSION: The results demonstrated no significant change in body composition parameters within the first 30 days of SGLT2 inhibitor therapy. However, by 90 days, there was a significant fall in body composition in terms of body weight, BMI, body fat mass, and visceral fat. No changes were observed in skeletal muscle mass and fluid composition during follow-up. The discrepancy in body composition could be due to variation in the patients' baseline measures and lifestyle habits, including diet and physical activity. Our study was limited by its short duration and use of BIA, which is an easy, non-invasive, and more practical modality, but lacks the precision of imaging modalities like DXA or MRI. Furthermore, muscle function was not assessed, which would provide more clinical relevance in interpreting muscle mass changes. CONCLUSION: Short-term (90-day) SGLT2 inhibitor therapy, primarily Dapagliflozin in T2DM patients, resulted in statistically substantial reductions in BW, BMI, BFM, and visceral fat percentage, with preservation of SMM and fluid balance. Future studies should target a larger sample size, longer follow-up durations, and include assessment of muscle strength. Additionally, the effect of lifestyle modification along with drugs on body composition can also be investigated.

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