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Dapagliflozin and Metformin Reduce Dangerous Visceral Abdominal Fat

How Dapagliflozin and Metformin Reduce Dangerous Visceral Abdominal Fat and Reduce Heart Disease in Diabetic Individuals

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Type 2 diabetes is more than just high blood sugar—it’s a complex condition that increases the risk of serious health issues like heart disease and stroke. Recent research has shed light on how certain diabetes medications not only control blood sugar but also reduce harmful abdominal fat that contributes to cardiovascular risk. This article explores a groundbreaking study that examined the effects of two commonly prescribed medications, metformin and dapagliflozin, on specific layers of abdominal fat in people with type 2 diabetes and obesity.

Understanding the Link Between Abdominal Fat and Health Risks

Abdominal fat isn’t all the same. It’s divided into different layers, each with unique impacts on health:

  • Subcutaneous Fat: Located just under the skin, divided into superficial and deep layers.
  • Preperitoneal Fat: Situated in front of the peritoneum (the lining of the abdominal cavity).
  • Omental Fat: Found around the internal organs within the abdomen.
  • Perirenal Fat: Surrounds the kidneys.

Excess fat in the omental and perirenal areas is particularly harmful, as it’s associated with increased insulin resistance, metabolic syndrome, and cardiovascular diseases.

The Medications: Metformin and Dapagliflozin

  • Metformin: A first-line medication for type 2 diabetes that improves insulin sensitivity and lowers glucose production in the liver.
  • Dapagliflozin: An SGLT2 inhibitor that promotes the excretion of glucose through urine, leading to lower blood sugar levels and potential weight loss.

The Study at a Glance

A clinical trial named Omendapa investigated how these medications affect abdominal fat layers.

  • Participants: 29 individuals aged 50-75, newly diagnosed with type 2 diabetes (diagnosed within the last 12 months) and obesity (BMI > 30 kg/m²).
  • Design: Randomized into two groups:
    • Group A: 14 patients received metformin alone (up to 1,700 mg per day).
    • Group B: 15 patients received metformin (same dosage) plus dapagliflozin (10 mg per day).
  • Duration: 6 months.
  • Diet: All participants followed a calorie-restricted diet, consuming 500 fewer calories per day than their estimated needs.
  • Measurements: Weight, abdominal circumference, body fat percentage, blood tests, and ultrasound imaging of abdominal fat layers.

Key Findings

  1. Weight Loss and Abdominal Circumference Reduction
    • Group A (Metformin alone):
      • Weight Loss: Average of 5.5 kg (about 12 pounds), which is a 5.7% reduction from their initial weight.
      • Abdominal Circumference: Decreased by 2.7 cm (about 1 inch).
    • Group B (Metformin + Dapagliflozin):
      • Weight Loss: Average of 8.4 kg (about 18.5 pounds), an 8.6% reduction.
      • Abdominal Circumference: Decreased by 7.4 cm (about 2.9 inches).
    • Interpretation: While both groups lost weight, the combination therapy led to significantly greater reductions in both weight and waist size. A smaller waist circumference is linked to lower risk of heart disease.
  2. Reduction in Harmful Abdominal Fat Layers
    • Omental Fat:
      • Both groups saw a significant reduction of about 20 mm (2 cm) in omental fat thickness.
      • Group A: 21.7% reduction.
      • Group B: 21.8% reduction.
    • Perirenal Fat:
      • Group A:
        • Left kidney: 4.4% reduction.
        • Right kidney: 8.5% reduction.
      • Group B:
        • Left kidney: 20.4% reduction.
        • Right kidney: 23.9% reduction.
      • Interpretation: The combination of metformin and dapagliflozin significantly reduced the fat surrounding the kidneys, which is associated with better cardiovascular outcomes.
  3. Improvement in Blood Sugar Control and Insulin Resistance
    • HbA1c Levels (Average Blood Sugar Over 3 Months):
      • Group A: Decreased by 0.9% (from an average of 7.5% to 6.6%).
      • Group B: Decreased by 1.1% (from an average of 7.3% to 6.2%).
      • Interpretation: Lower HbA1c levels indicate better blood sugar control. Both groups improved, with a trend toward greater improvement in the combination therapy group.
    • HOMA-IR (Measure of Insulin Resistance):
      • Group A: Decreased by 3.2 units.
      • Group B: Decreased by 6.7 units.
      • Interpretation: A larger decrease in HOMA-IR suggests that the combination therapy more effectively improved insulin sensitivity.
  4. Correlation with Cardiovascular Risk Markers
    • In the combination therapy group, reductions in omental fat were associated with decreases in:
      • Leptin: A hormone linked to fat storage and hunger signals.
        • Correlation coefficient (r): 0.51 (p = 0.02).
      • C-reactive Protein (CRP): A marker of inflammation in the body.
        • r: 0.47 (p = 0.002).
      • Microalbuminuria (MAL): Indicates kidney stress or damage.
        • r: 0.41 (p < 0.001).
      • Interpretation: Positive correlations mean that as omental fat decreased, these risk markers also improved, suggesting a reduction in cardiovascular risk.

Understanding the Numbers

  • Correlation Coefficient (r): Measures the strength and direction of a relationship between two variables.
    • Range: -1 to 1.
      • Positive values: As one variable increases, so does the other.
      • Negative values: As one variable increases, the other decreases.
    • Strength:
      • 0.1 to 0.3: Weak correlation.
      • 0.3 to 0.5: Moderate correlation.
      • 0.5 to 1.0: Strong correlation.
  • P-value: Indicates the probability that the result is due to chance.
    • P < 0.05: Statistically significant (less than a 5% chance the result is random).
    • Interpretation: The correlations found in this study are statistically significant, meaning they’re likely reflecting true relationships.

Why This Matters

  • Targeting Harmful Fat: Reducing omental and perirenal fat can lower the risk of heart disease and improve overall metabolic health.
  • Enhanced Benefits with Combination Therapy: Adding dapagliflozin to metformin not only aids in weight loss but specifically reduces fat associated with higher cardiovascular risk.
  • Improved Insulin Sensitivity: Better insulin sensitivity means the body’s cells can more effectively use glucose, reducing blood sugar levels and the need for insulin production.
  • Non-Invasive Monitoring: Ultrasound imaging offers a safe and accessible way to monitor changes in abdominal fat, guiding treatment decisions.

Practical Takeaways

  • Medication Choices: For individuals with type 2 diabetes and obesity, combining metformin with dapagliflozin might offer superior benefits in reducing harmful fat and improving heart health.
  • Lifestyle Still Matters: All participants followed a calorie-restricted diet, highlighting the importance of diet alongside medication.
  • Monitoring Progress: Regular check-ups, including blood tests and possibly ultrasound imaging, can help track the effectiveness of treatment.

Safety and Side Effects

  • General Tolerance: Both treatments were well-tolerated with no serious adverse events.
  • Common Side Effects: Some patients experienced gastrointestinal discomfort, leading to a reduced metformin dose.
  • Consult Healthcare Providers: Always discuss potential side effects and the best treatment options with a healthcare professional.

Conclusion

The combination of metformin and dapagliflozin offers a promising approach to managing type 2 diabetes by not only controlling blood sugar but also reducing harmful abdominal fat linked to cardiovascular risks. This study underscores the potential of these medications to improve metabolic health and reduce the burden of heart disease in people with diabetes and obesity. 

Frequently Asked Questions (FAQs)

What is the significance of reducing omental and perirenal fat?

These fat layers are linked to higher risks of insulin resistance, metabolic syndrome, and cardiovascular diseases. Reducing them can lower these risks.

How does dapagliflozin help in weight loss?

Dapagliflozin promotes the excretion of excess glucose through urine, leading to a loss of calories and subsequent weight loss.

Is ultrasound imaging commonly used to measure abdominal fat?

While not as common as other imaging methods, ultrasound offers a non-invasive, accessible way to assess specific abdominal fat layers.

Are there any dietary recommendations when taking these medications?

A balanced, calorie-controlled diet enhances the effectiveness of these medications. Consult a healthcare provider for personalized advice.

Disclaimer: This article is for informational purposes only and does not substitute professional medical advice. Always consult a qualified healthcare provider for guidance tailored to your health situation.


At BorderFreeHealth, we’re dedicated to providing up-to-date information and quality medications to support your health needs. Explore our range of GLP-1 receptor agonists and consult with our pharmacists for more information.

Medically Reviewed

Profile image of Dr Pawel Zawadzki

Medically Reviewed By Dr Pawel ZawadzkiDr. Pawel Zawadzki, a U.S.-licensed MD from McMaster University and Poznan Medical School, specializes in family medicine, advocates for healthy living, and enjoys outdoor activities, reflecting his holistic approach to health.

Profile image of Dr Pawel Zawadzki

Written by Dr Pawel ZawadzkiDr. Pawel Zawadzki, a U.S.-licensed MD from McMaster University and Poznan Medical School, specializes in family medicine, advocates for healthy living, and enjoys outdoor activities, reflecting his holistic approach to health. on February 4, 2025

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