Energy balance
SGLT2 inhibitors produce significantly less weight loss than predicted by urinary glucose excretion because of compensatory hyperphagia (increased energy intake).
If you are taking an SGLT2 inhibitor (like Jardiance or Farxiga), expect about 2-3 kg of weight loss, not the 7 kg you might calculate based on urine sugar loss. Your body will likely increase your hunger to compensate for the calories lost in urine. To maximize weight loss, you must actively manage your appetite and food intake, as the drug alone will not overcome this biological compensation.
It has been speculated that the discrepancy between observed and expected weight loss with SGLT2i may arise because of compensatory increases in energy intake and changes in energy expenditure that act to attenuate the energy imbalance. In rodent models, SGLT2 deletion or chronic treatment with the SGLT2i dapagliflozin resulted in a compensatory increase in caloric intake.
Why this rating
Supported by rodent models and mathematical modeling in humans, though direct human interventional data on intake is noted as a paucity.
Source
Weight loss variability with SGLT2 inhibitors and GLP‐1 receptor agonists in type 2 diabetes mellitus and obesity: Mechanistic possibilities
Emily Brown et al. · Obesity Reviews · 2019
DOI 10.1111/obr.12841
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