Relationship of dietary intake and eating behaviors with glycemic control and body weight under long-term treatment with dapagliflozin: an exploratory prospective study

Sodium glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control and reduce body weight (BW) in individuals with type 2 diabetes. However, there are still concerns that compensatory hyperphagia may affect their effects. Here, we performed an exploratory prospective study to investigate whether dietary intake and/or eating behaviors affect glycemic control and BW under long-term treatment with dapagliflozin. Fifty-three Japanese individuals with type 2 diabetes received dapagliflozin 5 mg daily for 104 weeks, with frequent assessments of HbA1c, BW, body composition, dietary intake, and eating behaviors. Dietary intake was evaluated using a brief self-administered diet history questionnaire, and eating behavior was evaluated using the Dutch Eating Behavior Questionnaire. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019192). At 104 weeks, HbA1c decreased by 0.5% and BW decreased by 2.8 kg (both p < 0.001), with a dominant decrease in body fat mass by 2.2 kg (p < 0.001). No significant change was observed in calorie intake or the proportion of carbohydrates, protein, and fat. The change (∆) in HbA1c was significantly correlated with basal HbA1c, basal triglyceride levels, ∆BMI (body mass index), ∆BFP (body fat percentage), and ∆ferritin levels. The ∆BMI was significantly correlated with only the ∆BFP. Neither the ∆HbA1c nor ∆BMI was significantly correlated with dietary intake, any type of eating behavior, or changes in these parameters during this study. In conclusion, dapagliflozin treatment improved glycemic control and reduced BW without being affected by any changes in dietary intake or eating behavior over 104 weeks.