Clinical Effects of Sodium-Glucose Transporter Type 2 Inhibitors in Patients With Partial Lipodystrophy

Endocr Pract. 2022 Jun;28(6):610-614. doi: 10.1016/j.eprac.2022.03.006. Epub 2022 Mar 14.


Objective: Severe insulin resistance syndromes, such as lipodystrophy, lead to diabetes, which is challenging to control. This study explored the safety and efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in a series of 12 patients with severe insulin resistance due to partial lipodystrophy.

Methods: A retrospective chart review of the safety (N = 22) and efficacy (N = 12) of SGLT2is in patients with partial lipodystrophy was conducted at our institution. The efficacy outcomes included hemoglobin A1C level, insulin dose, fasting plasma glucose level, C-peptide level, lipid profile, 24-hour urinary glucose excretion, estimated glomerular filtration rate, and blood pressure before and after 12 months of SGLT2i treatment.

Results: The hemoglobin A1C level decreased after SGLT2i treatment (at baseline: 9.2% ± 2.0% [77.0 ± 21.9 mmol/mol]; after 12 months: 8.4% ± 1.8% [68.0 ± 19.7 mmol/mol]; P = .028). Significant reductions were also noted in systolic (P = .011) and diastolic blood pressure (P = .013). There was a trend toward a decreased C-peptide level (P = .071). The fasting plasma glucose level, lipid level, and estimated glomerular filtration rate remained unchanged. The adverse effects included extremity pain, hypoglycemia, diabetic ketoacidosis (in a patient who was nonadherent to insulin), pancreatitis (in a patient with prior pancreatitis), and fungal infections.

Conclusion: SGLT2is reduced the hemoglobin A1C level in patients with partial lipodystrophy, with a similar safety profile compared with that in patients with type 2 diabetes. After individual consideration of the risks and benefits of SGLT2is, these may be considered a part of the treatment armamentarium for these rare forms of diabetes, but larger trials are needed to confirm these findings.

Keywords: SGLT2 inhibitors; diabetes; partial lipodystrophy; severe insulin resistance.

MeSH terms

  • Blood Glucose
  • C-Peptide / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy
  • Glucose Transporter Type 2 / therapeutic use
  • Glycated Hemoglobin / metabolism
  • Humans
  • Insulin / therapeutic use
  • Insulin Resistance*
  • Lipodystrophy* / complications
  • Lipodystrophy* / drug therapy
  • Pancreatitis / chemically induced
  • Retrospective Studies
  • Sodium-Glucose Transporter 2 Inhibitors* / adverse effects
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use


  • Blood Glucose
  • C-Peptide
  • Glucose Transporter Type 2
  • Glycated Hemoglobin A
  • Insulin
  • Sodium-Glucose Transporter 2 Inhibitors

Supplementary concepts

  • Lipodystrophy, Partial, Acquired