Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 15


Thursday, Apr 25
12:00 PM – 12:30 PM

Objective : Patients who have underwent metabolic surgery are at risk for weight regain. Limited evidence exists on the effects of sodium-glucose cotransporter-2 inhibitors on cardiometabolic parameters in patients who have underwent metabolic surgery. The aim of the trial was to elucidate the effects of canagliflozin on clinical parameters in type II diabetes (T2D) subjects who underwent metabolic surgery.

Methods : A prospective, randomized, and double-blinded trial was instituted to recruit post-metabolic surgery patients (Roux-en-Y gastric bypass or sleeve gastrectomy). Patients allocated into the control or medication group met specific inclusion criteria: diagnosed with T2D, hemoglobin A1c (HbA1c) > 6.5%, 18-75 years of age, and underwent metabolic surgery at least one year prior, but < 15 years ago. Subjects (n=16, 11 female) were enrolled in the study for six months. Baseline mean body mass index (BMI), age, and HbA1c, were 39.2 kg/m2, 54 years, and 7.4%, respectively. Using maximum likelihood estimation, a linear mixed effect model was conducted to deduce group differences. Mean changes (95% confidence intervals) in weight, BMI, body composition, and blood glucose were reported. A p-value < 0.05 was considered statistically significant.

Results : Mean changes in weight and BMI were significant between groups; furthermore, mean changes in percent body, lean, truncal, and android fat achieved statistical significance (p2 (-2.12,-0.36) in the medication group. Moreover, mean percent change in android and truncal fat were -3% (-5.67,-0.32) and -2.67% (-5.19,-0.16), respectively. Finally, fasting glucose significantly reduced by 32.90 mg/dL (-56.02,-9.79) after six months in the medication group (p<0.05). 

Discussion : Given that canagliflozin fostered weight loss in patients who underwent metabolic surgery, the implications are clinically relevant. The concurrent application of canagliflozin and metabolic surgery in patients who are obese and diagnosed with T2D can be beneficial. Specifically, their synergistic effects translate into favorable weight loss outcomes and possibly further reductions in cardiovascular risk. The addition of canagliflozin as therapy in patients who have undergone metabolic surgery can amplify weight loss outcomes acutely post-surgery and/or mitigate weight regain long-term. 

Conclusion : Canagliflozin can foster improved weight loss outcomes in patients who have underwent metabolic surgery. In turn, there may be a further reduction in cardiovascular disease risk. 


Karim Kheniser

Research Coordinator
Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio.

Research Coordinator at Cleveland Clinic Foundation.

James Bena

Principal Biostatistician
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Cleveland, Ohio

Lead Biostatistician, Quantitative Health Sciences, Cleveland Clinic

Sangeeta Kashyap

Professor of Medicine
Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio.

medical school: University of Texas Health Science Center at San Antonio San Antonio, TX
University of California-Irvine College of Medicine Irvine, CA

specialty training: Fellowship - Veterans Administration Greater Los Angeles Healthcare System Los Angeles, CA
Residency - Saint Elizabeth's Medical Center Boston, MA
Internship - George Washington University School of Medicine and Health Sciences Washington, DC

other education: Undergraduate - University of California at Irvine Irvine, CA

specialty interests: Diabetes, general endocrinology, hyperlipidemia, insulin resistance, cardiovascular risk prevention, lipid disorders, metabolic syndrome, metabolism, obesity

Philip Schauer

Director, Bariatric & Metabolic Institute
Cleveland Clinic, Bariatric and Metabolic Institute, Cleveland, OH, USA.

appointed: 2004
medical school: Baylor College of Medicine Houston, TX

specialty training: Fellowship - Duke University Medical Center Durham, NC
Residency - University of Texas Health Science Center at San Antonio San Antonio, TX
Internship - University of Texas Health Science Center at San Antonio San Antonio, TX

other education: Undergraduate - Texas A & M University College Station, TX

specialty interests: Bariatric Surgery, colon surgery, gastrointestinal surgery, Laparoscopic Surgery, weight loss surgery, Weight Management