Effect of the sodium glucose co-transporter 2 inhibitor canagliflozin on plasma volume in patients with type 2 diabetes mellitus

Diabetes Obes Metab. 2014 Nov;16(11):1087-95. doi: 10.1111/dom.12322. Epub 2014 Jul 8.

Abstract

Aim: To evaluate the effects of canagliflozin on plasma volume, urinary glucose excretion (UGE), fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and additional measures of fluid/electrolyte balance in patients with type 2 diabetes on background therapy with metformin and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Methods: Patients (N = 36) were randomized (1:1) to receive canagliflozin 300 mg or placebo for 12 weeks. Pharmacodynamic parameters were assessed at baseline and at weeks 1 and 12.

Results: Increased 24-h UGE was seen in the canagliflozin group compared with a reduction in the placebo group at both week 1 (91.8 vs. -2.4 g) and week 12 (82.6 vs. -0.4 g). Canagliflozin also reduced both FPG and HbA1c. Reductions in body weight and blood pressure were observed at weeks 1 and 12. Canagliflozin decreased plasma volume compared with an increase with placebo at week 1 (-5.4 vs. 4.3%; p = 0.02), but this was largely attenuated at week 12 (4.6 vs. 5.8%; p = 0.76). A modest numerical increase in urine volume was observed with canagliflozin at week 1 that was attenuated at week 12; other measures of volume status (i.e. blood urea nitrogen, serum creatinine and haematocrit) remained modestly increased with canagliflozin at week 12.

Conclusion: Canagliflozin provided sustained effects on UGE and FPG over 12 weeks and a transient reduction in plasma volume that was largely attenuated by week 12.

Keywords: SGLT2 inhibitor; antihypertensive therapy; metformin; pharmacodynamics; phase I-II study; type 2 diabetes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • Blood Pressure / drug effects*
  • Body Weight / drug effects
  • Canagliflozin
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetic Angiopathies / prevention & control*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Fasting
  • Female
  • Glucosides / therapeutic use*
  • Glycated Hemoglobin A / drug effects
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypertension / prevention & control*
  • Hypoglycemic Agents / therapeutic use
  • Kidney / drug effects
  • Kidney / metabolism
  • Male
  • Metformin / therapeutic use
  • Middle Aged
  • Plasma Volume / drug effects*
  • Sodium-Glucose Transporter 2 Inhibitors*
  • Thiophenes / therapeutic use*
  • Treatment Outcome
  • Water-Electrolyte Balance / drug effects
  • Weight Loss / drug effects

Substances

  • Antihypertensive Agents
  • Blood Glucose
  • Glucosides
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Thiophenes
  • hemoglobin A1c protein, human
  • Canagliflozin
  • Metformin