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Research

Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-081820 (Published 22 January 2025) Cite this as: BMJ 2025;388:e081820

Linked Editorial

SGLT2 inhibitors and dietary calorie restriction for type 2 diabetes remission

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Re: Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial

Dear Editor,
I came across the recent study on the remission of type 2 diabetes using dapagliflozin combined with calorie restriction. Though the findings are promising, certain limitations need further discussion.
The article highlights the success of weight loss in causing remission, but it does not address the challenges in maintaining remission in the long term. Studies have shown that maintaining remission for prolonged periods is still difficult, even though early remission rates can be high. For instance,[1] studies show that just 6% of people with diabetes were able to achieve remission with weight loss alone about 8 years after diagnosis, and of those who did, 2/3 returned to having high blood glucose levels within 3 years. The study's short follow-up period (12 months with a 2-month extension) limitation to the study
The study's other limitation is generalizability. It is focused solely on China with only overweight/obese individuals (BMI >25); its findings may not apply to leaner populations with type 2 diabetes, who may have different pathophysiologies. Additionally, psychosocial factors like adherence, emotional eating, and distress of diabetes were not assessed, yet they significantly influence long-term success.
Moreover, the study provides insufficient data on adverse events associated with SGLT2 inhibitors, such as UTI, euglycemic ketoacidosis, and dehydration. More data on safety analysis is necessary. Lastly, this approach's [2] cost-effectiveness remains unclear, as the affordability of long-term dapagliflozin use may be a barrier to widespread adoption.
Future research should address these limitations; incorporating these aspects would offer readers a more nuanced understanding of the complexities of achieving and maintaining type 2 diabetes remission.

Reference
1.https://www.eurekalert.org/news-releases/1031292?utm
2.https://link.springer.com/article/10.1007/s12325-024-02919-5?utm

Competing interests: No competing interests

12 February 2025
Chandana Tadigotla
physician
P E S Institute of Medical Sciences and Research
NH- 219, Kuppam, Beggilipalle, Andhra Pradesh 517425, India

Re: Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial

Dear Editor,

'Remission' in T2DM, vaguely described earlier, has now acquired fair clarity. SGLT2 inhibitors of almost a decade of usage form an important component of therapeutic armamentarium, GLP 1 group notwithstanding. Dapaglifozine, much studied in landmark therapeutic trials, and highlighted for the organoprotective properties noticed has been a standard and reliable prototype of the group.

Intense reduction in calories (VLC diet) was advocated but impractical on a long term basis in view of lack of sustained compliance. This trial of Dapaglifozin plus calorie restriction, for remission in T2DM, claimed first of it kind, therefore requires to be looked into critically concerning whether standard practices have been followed and results rightly concluded. In a number of subjects, with methodology followed and duration and criteria of remission defined, it stands to reason, with hardly a limitation. The ethnicity of subjects and dietary composition may limit extrapolation to other populations in the world but can provide the impetus to corroborate and confirm the results obtained.

Prof ME Yeolekar, Mumbai.

Competing interests: No competing interests

28 January 2025
Murar E Yeolekar
Consultant Cardiometabolic Physician
Fmr Prof & Head of Internal Medicine, KJSMC&LTMMC
Sion, Mumbai-400 022
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