title: Effects of a sodium glucose co-transporter 2 selective inhibitor, ipragliflozin, on the diurnal profile of plasma glucose in patients with type 2 diabetes: A study using continuous glucose monitoring.
abstract: OBJECTIVE
  To assess the effects of sodium glucose co-transporter 2 inhibitor therapy on the pathophysiology of type 2 diabetes.
  
  
  METHODS
  We administered ipragliflozin to 21 inpatients with type 2 diabetes for 7 days, and analyzed the diurnal profiles of plasma glucose and 3-hydroxybutyrate. A total of 21 age-, sex- and body mass index-matched diabetic patients served as controls.
  
  
  RESULTS
  Continuous glucose monitoring showed that the 24-h glucose curve was shifted downward without hypoglycemia by the administration of ipragliflozin. The average glucose level was reduced from 182 ± 54 mg/dL to 141 ± 33 mg/dL (P < 0.0001). The magnitude of the reduction was highly correlated with the baseline average glucose level. Homeostasis model assessment of insulin resistance was decreased, and homeostasis model assessment of β-cell function was increased during the treatment. Urinary glucose excretion was correlated with the average glucose level both on day 0 and on day 7, although the regression line was steeper and shifted leftward on day 7. The ipragliflozin-treated patients lost more weight than the control patients (1.4 ± 0.5 vs 0.5 ± 0.6 kg, P < 0.0001). Plasma levels of 3-hydroxybutyrate were significantly increased with peaks before breakfast and before dinner. Patient age and bodyweight loss were negatively and positively correlated with the peak levels of 3-hydroxybutyrate on day 7, respectively.
  
  
  CONCLUSIONS
  The ipragliflozin treatment improved the 24-h glucose curve without causing hypoglycemia. The close correlation between the magnitude of glucose reduction and the baseline plasma glucose concentration suggests that the risk of hypoglycemia is likely low. It might be prudent to monitor ketone body levels in younger patients and in patients with rapid weight loss.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Yoshinobu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Munehisa
authors.initials: M
authors.lastname: Tsuruta
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nohara
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Hasuo
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Akasu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tokubuchi
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Wada
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Hirao
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kaku
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine Kurume, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tajiri
keywords: 3-Hydroxybutyrate; Continuous glucose monitoring; Sodium glucose co-transporter inhibitor