Glycaemic and weight-loss outcomes of graded doses of canagliflozin in type 2 diabetes — a real-world study
, 1, , ,
Abstract
Background. Costs are the most important cause of therapeutic non-compliance. Half canagliflozin (CANA)–300 tablet has lowest cost/mg among all CANA preparations; data are unavailable on efficacy of half CANA-300. This study evaluated weight loss and glycaemic outcomes of 100 mg versus 150 mg versus 300 mg of canagliflozin as part of standard therapy.
Methods. Data, retrospectively captured from medical records of two centres in Delhi for patients > 35 years with type-2 diabetes (T2DM), and on canagliflozin, having > 6 months follow-up, were analysed. Patients were in 3-groups depending on canagliflozin dosage: Group 1 on canagliflozin 100 mg/day (1 tablet CANA-100), Group-2 on canagliflozin 150 mg/day (half tablet CANA-300), and Group 3 on canagliflozin 300 mg/day (1 tablet CANA-300). Primary endpoints were glycaemic
efficacy and weight-loss.
Results. From 3,569 records evaluated, 1,232 people with T2DM on canagliflozin were screened; data from 528 individuals analysed (257, 138 and 133 in Groups: 1, 2 and 3 respectively). People in all three groups were comparable with regards to sex, T2DM duration, glycated haemoglobin (HbA1c), haemoglobin, creatinine, lipids, albuminuria and medications. Group-2 patients were youngest and had highest BMI. Following 6-months, both absolute and percent weight-loss was significantly higher in Group-2 (–3.5 kg [–6.60–0.00]; –3.62%), followed by Group-3 (–3.0 kg [–5.3 to –0.8]; –3.33%), and lowest in Group-1 (–1.05 kg [–2.85 to –0.17]; –1.31%) (P = 0.002 and 0.014, respectively). Glycaemic efficacy was comparable among groups.
Conclusion. Half CANA-300 tablet has comparable glycaemic efficacy and weight-loss compared to single CANA-300 tablet, but superior weight-loss compared to CANA-100.
Keywords: obesity canagliflozinweight lossdiabetes reversaleuglycaemiatype 2 diabetescost analysis
References
- Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res. 2016; 143(4): 401–404.
- Dutta D, Choudhuri S, Mondal SA, et al. Urinary albumin : creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014; 6(4): 316–322.
- Mondal SA, Dutta D, Kumar M, et al. Neck circumference to height ratio is a reliable predictor of liver stiffness and nonalcoholic fatty liver disease in prediabetes. Indian J Endocrinol Metab. 2018; 22(3): 347–354.
- Deepa M, Grace M, Binukumar B, et al. CARRS Surveillance Research Group. High burden of prediabetes and diabetes in three large cities in South Asia: The Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study. Diabetes Res Clin Pract. 2015; 110(2): 172–182.
- Singla R, Garg A, Singla S, et al. Temporal change in profile of association between diabetes, obesity, and age of onset in urban India: a brief report and review of literature. Indian J Endocrinol Metab. 2018; 22(3): 429–432.
- Dutta D, Jaisani R, Khandelwal D, et al. Role of Metformin, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Orlistat based Multidrug Therapy in Glycemic Control, Weight Loss, and Euglycemia in Diabesity: A Real-World Experience. Indian J Endocrinol Metab. 2019; 23(4): 460–467.
- Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018; 391(10120): 541–551.
- Singh AK, Unnikrishnan AG, Zargar AH, et al. Evidence-Based Consensus on Positioning of SGLT2i in Type 2 Diabetes Mellitus in Indians. Diabetes Ther. 2019; 10(2): 393–428.
- Devineni D, Murphy J, Wang SS, et al. Absolute oral bioavailability and pharmacokinetics of canagliflozin: A microdose study in healthy participants. Clin Pharmacol Drug Dev. 2015; 4(4): 295–304.
- Singh AK, Singh R. Spotlight on Canagliflozin 300: review of its efficacy and an indirect comparison to other SGLT-2 inhibitors and long-acting GLP-1 receptor agonists. Expert Rev Clin Pharmacol. 2017; 10(6): 633–647.
- Mentock SM, Ng VY, Narayana R, et al. Treatment-seeking behavior and obstacles to treatment compliance in diabetic patients in Mangaluru, India. Diabetes Metab Syndr. 2017; 11 Suppl 2: S617–S622.
- Dalvi V, Mekoth N. Patient non-adherence: an interpretative phenomenological analysis. Int J Health Care Qual Assur. 2017; 30(3): 274–284.
- 1mg. Canagliflozin 100mg tablet online purchase. https://www.1mg.com/drugs/invokana-100mg-tablet-173290 (12.01.2020).
- 1mg. Canagliflozin 300mg tablet online purchase. https://www.1mg.com/drugs/motivyst-tablet-332650 (12.01.2020).
- Sharma M, Kumar M, Dutta D. Hydroxychloroquine in diabetes and dyslipidaemia: primum non nocere. Diabet Med. 2020; 37(8): 1404–1405.
- 1mg. Actrapid online purchase with a valid prescription. https://www.1mg.com/drugs/actrapid-hm-100iu-ml-penfill-248417 (12.01.2020).
- 1mg. Insulatard online purchase with a valid prescription. https://www.1mg.com/drugs/insulatard-hm-100iu-ml-penfill-372998 (12.01.2020).
- 1mg. Humalog online purchase with a valid prescription. https://www.1mg.com/drugs/humalog-100iu-ml-solution-for-injection-341834 (12.01.2020).
- 1mg. Lantus online purchase with a valid prescription. https://www.1mg.com/drugs/lantus-100iu-ml-solution-for-injection-113528 (12.01.2020).
- Dutta D, Ghosh S. Young-onset diabetes: An Indian perspective. Indian J Med Res. 2019; 149(4): 441–442.
- Polidori D, Sha S, Mudaliar S, et al. Canagliflozin lowers postprandial glucose and insulin by delaying intestinal glucose absorption in addition to increasing urinary glucose excretion: results of a randomized, placebo-controlled study. Diabetes Care. 2013; 36(8): 2154–2161.
- Sha S, Devineni D, Ghosh A, et al. Canagliflozin, a novel inhibitor of sodium glucose co-transporter 2, dose dependently reduces calculated renal threshold for glucose excretion and increases urinary glucose excretion in healthy subjects. Diabetes Obes Metab. 2011; 13(7): 669–672.
- Singh AK, Singh R. Spotlight on Canagliflozin 300: review of its efficacy and an indirect comparison to other SGLT-2 inhibitors and long-acting GLP-1 receptor agonists. Expert Rev Clin Pharmacol. 2017; 10(6): 633–647.
- Shyangdan DS, Uthman OA, Waugh N. SGLT-2 receptor inhibitors for treating patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. BMJ Open. 2016; 6(2): e009417.
- Zaccardi F, Webb DR, Htike ZZ, et al. Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis. Diabetes Obes Metab. 2016; 18(8): 783–794.
- Freeman MK, White W, Iranikhah M. Tablet splitting: a review of the clinical and economic outcomes and patient acceptance. Second of a 2-part series. Part 1 was published in May 2012 (Consult Pharm 2012;27:239-53). Consult Pharm. 2012; 27(6): 421–430.