Increased grip strength with sodium–glucose cotransporter 2

In the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes trial (EMPA-REG OUTCOME) study, empagliflozin, a sodium–glucose cotransporter 2 (SGLT2) inhibitor, significantly reduced the risk of cardiovascular death and hospitalization for heart failure among patients with type 2 diabetes (T2D) and established cardiovascular disease. Possible mechanisms for these benefits include decreased blood pressure, visceral fat reduction, weight loss, and volume reduction due to a mild diuretic effect. Sarcopenia is a loss of muscle mass, resulting in reduced strength and functional decline, and in association with diabetes is a major public health concern because it leads to frailty and mortality. Subjects with diabetes exhibit a progressive decline in muscle mass and quality, caused by reduced insulin sensitivity, hormone imbalance, decreased mitochondrial function, and reduced muscle regenerative capacity. In turn, reduced physical activity further worsens sarcopenia. There remains a lack of consensus as to how to screen for sarcopenia. A recent large longitudinal study revealed that hand grip strength was inversely associated with all-cause mortality, cardiovascular mortality, and myocardial infarction in the general population. Measurement of maximal hand grip strength could be a simple and inexpensive method for cardiovascular risk stratification among subjects with T2D. We examined the change in maximal hand grip strength before and after SGLT2 inhibitor treatment. The study was performed on 112 Japanese subjects with T2D (92 men, 20 women). In men, mean (± SD) age, baseline body mass index (BMI), and HbA1c was 62.8±10.2 years, 25.6± 4.5 kg/m, and 7.0± 1.3%, respectively. In women, mean (± SD) age, baseline BMI, and HbA1c was 65.2 ±9.0years, 24.5±4.3kg/m, and 7.3±1.5%, respectively. Subjects were treated with ipragliflozin 50mg, luseogliflozin 2.5mg, or dapagliflozin 5 or 10mg daily for at least 4weeks. The mean (± SD) observation period was 10.3±2.9weeks after SGLT2 inhibitor treatment. In both men and women, grip strength increased in both hands after SGLT2 inhibitor treatment (P< 0.01, paired t-test; Fig. 1). These findings were