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

J Diabetes Investig. 2018 Jul;9(4):875-881. doi: 10.1111/jdi.12774. Epub 2017 Dec 4.

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.

Keywords: Hypertension; Sodium-glucose cotransporter inhibitor; Thiazide diuretics.

MeSH terms

  • Aged
  • Blood Pressure / drug effects*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Female
  • Glucosides / therapeutic use*
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Hypertension / metabolism
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Sodium Chloride Symporter Inhibitors / therapeutic use*
  • Sodium-Glucose Transporter 2
  • Sodium-Glucose Transporter 2 Inhibitors*
  • Thiophenes / therapeutic use*
  • Treatment Outcome

Substances

  • Glucosides
  • Hypoglycemic Agents
  • SLC5A2 protein, human
  • Sodium Chloride Symporter Inhibitors
  • Sodium-Glucose Transporter 2
  • Sodium-Glucose Transporter 2 Inhibitors
  • Thiophenes
  • ipragliflozin