Background: Diabetes is a progressive disease needing multiple drugs for achieving and maintaining good glycemic control. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a relatively novel class of anti-diabetic agents which offer several beneficial effects, such as weight loss and blood pressure reduction in addition to their hypoglycemic effect. However, the long-term effectiveness in clinical practice and safety data of SGLT2 inhibitors is limited.
Material and Method: This retrospective observational study used data obtained from database of diabetic patients who had been prescribed SGLT2i and continue to use at least 6 months between November 1, 2014 and June 30, 2016 in Theptarin Hospital, a multi-discipline based diabetes center in Bangkok. 
Results: A total of 189 diabetic patients (females 50.3%, mean age 59.9±12.3 years, T2DM 97.3%, duration of diabetes 16.3±9.2 years, baseline BMI 29.9±6.1 kg/m2, baseline A1C 8.8±1.6%) were prescribed SGLT2i during study period. At the time of first SGLT2i prescription, 80.4% used three or more other oral hypoglycemic agents (OHA) concomitantly and 34.6% used insulin concomitantly. Forty-three patients (22.8%) discontinued SGLT2i within the first 24 weeks of treatment. One hundred forty-six patients who continue to use at least 6 months (duration of treatment 13.1±5.5 months) were included in analysis.  At six months, mean A1C reduced from 8.8±1.5% to 7.9±1.3% and weight reduced from 78.3±18.0 kgs to 75.7±17.3 kgs. However, weight loss gradually rebounded after the first 6 months. At the last follow-up (median time 11 months), overall median A1C reduction and weight reduction when compared with at baseline were 1.1% and 1.2 kgs, respectively. The proportion of all patients attaining A1C target (A1C < 7%) at the last follow-up was only 28.1%. The incidence of adverse drug reactions of special interest (polyuria, volume depletion-related events, urinary tract infection, genital infection, and hypoglycemia) was 2.1, 1.6, 2.1, 2.6, and 4.2%, respectively. No DKA occurred but one major episode of hypoglycemia after SGLT2i treatment which judged to be non-medicated related. No discontinuations were due to hypoglycemia.
Discussion: This real-world study demonstrated the diversity of recent SGLT2i usages with mainly prescribed in long-standing diabetes. The durability of glycemic control and observed weight loss were consistent with reported from clinical trials in the first 6 months but weight loss gradually rebounded after that. Whether these clinical advantages, in the context of the adverse effect profile, outweigh the additional cost compared with more established therapies need to be considered. Further studies should be done towards a better understanding of the benefit to risk ratio of treatment with SGLT2 inhibitors, a unique and anticipated anti-diabetic agent.

Effectiveness of long-term treatment with SGLT2 inhibitors: Real-world evidence from a diabetes center in Thailand