SGLT2 inhibitors are prescribed through online medical consultations.
6,400 yen (tax included, shipping and consultation fees included) / Consultations available daily from 9:00 to 22:00, with same-day shipping possible.
What are SGLT2 inhibitors? A mechanism to lose weight by "expelling" sugar
There are several approaches to medical weight loss, such as suppressing appetite or inhibiting fat absorption. SGLT2 inhibitors differ from these by supporting weight management through a mechanism that expels sugar from the body along with urine. This medication is often chosen by individuals who find it difficult to restrict their diet.
Originally, these drugs were widely used in insured medical care as a treatment for type 2 diabetes and have accumulated a track record of use. At our clinic, we prescribe them through online consultations and deliver them to your home with same-day shipping available.
Positioning within medical weight loss
Medications used for medical weight loss are divided into "oral medications" and "injectable medications," with representative examples including GLP-1 receptor agonists, SGLT2 inhibitors, and traditional herbal medicines. While GLP-1 drugs act on the brain's satiety center to suppress appetite itself, SGLT2 inhibitors do not affect appetite but rather work by expelling ingested sugar. Since their approaches differ, which one is suitable depends on an individual's eating habits.
Mechanism of action of SGLT2 inhibitors
SGLT2 (Sodium-Glucose Cotransporter 2) is a protein found in the renal tubules of the kidneys, responsible for reabsorbing glucose into the bloodstream that would otherwise be excreted in the urine. SGLT2 inhibitors deliberately obstruct this reabsorption, causing excess sugar to be expelled from the body along with urine, thereby lowering blood sugar levels and supporting weight reduction.
Difference between SGLT2 and SGLT1, and key points in drug selection
Approximately 90% of the glucose that flows into the kidneys is reabsorbed by SGLT2, while the remaining approximately 10% is reabsorbed by SGLT1. SGLT1 has a stronger glucose-absorbing capacity than SGLT2 and is widely distributed not only in the kidneys but also in the small intestine, heart, brain, and other organs. SGLT2 inhibitors include drugs with high selectivity for SGLT2 and drugs with low selectivity that also act on SGLT1, and this difference is a key point in drug selection.
| Drugs with high SGLT2 selectivity (e.g., Lusefi, Forxiga) | Drugs with low SGLT2 selectivity (e.g., Canaglu, Suglat) | |
|---|---|---|
| Site of action | Mainly kidneys only | Acts on SGLT1 in addition to kidneys (e.g., small intestine) |
| Characteristics | Less impact on other organs, relatively few side effects | While highly effective at expelling sugar, note the risk of gastrointestinal symptoms, etc. |
| Suitable for | Older individuals who want to minimize side effect risk | Healthy young to middle-aged individuals seeking a strong effect |
List and comparison of medications
| Product Name | Generic Name | Approved Indications | Typical Dosage | Half-life | SGLT2 Selectivity |
|---|---|---|---|---|---|
| Lusefi | Luseogliflozin | Type 2 Diabetes | 2.5〜5mg | Approx. 10-12 hours | High |
| Forxiga | Dapagliflozin | Type 1 & 2 Diabetes, etc. | 5〜10mg | Approx. 10-12 hours | High |
| Canaglu | Canagliflozin | Type 2 Diabetes | 100mg | Approx. 10-12 hours | Low (also acts on SGLT1) |
| Suglat | Ipragliflozin | Type 1 & 2 Diabetes | 25〜100mg | Approx. 15 hours | Low (also acts on SGLT1) |
All medications are typically taken once daily, either before or after breakfast. Some drugs like Forxiga are also recommended in heart failure guidelines, attracting attention from perspectives other than diabetes treatment. The choice of medication will be determined by a doctor during the consultation, based on your constitution, age, existing conditions, and concomitant medications.
Expected diet effects
Theoretical calorie calculation
The action of SGLT2 inhibitors is said to excrete approximately 200 to 400 kcal of glucose in the urine per day. Converting this to a month, it amounts to 6,000 to 12,000 kcal. Since 1 kg of fat is approximately 7,000 kcal, this calculation theoretically results in a weight loss of approximately 1 kg per month.
However, actual weight loss does not always follow this exactly.
This is an important point. A study of empagliflozin taken for 90 weeks showed that while the predicted weight loss from excreted calories was an average of 11.3 kg, the actual measured weight loss was only an average of 3.2 kg. The main reason for this difference is a compensatory reaction where the body tries to make up for lost energy by increasing food intake by approximately 13% (about 269 kcal per day).
In other words, SGLT2 inhibitors are not a "magic pill that makes you lose weight automatically," but rather a drug where if you are mindful not to increase your food intake, that effort directly translates into results. Strict dietary restrictions are not necessary, but being careful not to unconsciously increase your food intake can significantly change the outcome. If you want to suppress your appetite itself, combining it with GLP-1 drugs is an option.
Furthermore, regarding the composition of the lost weight, a study adding dapagliflozin to metformin in individuals with type 2 diabetes confirmed significant weight loss compared to metformin alone, and the majority of this was reported to be due to fat reduction. Individual results may vary.
Timeframe for noticeable effects
Glucose excretion begins on the first day of taking the medication, but it takes several weeks to feel the effect on weight. The rate of reduction is not constant and generally slows down after a certain point.
For those who find it difficult to restrict their diet.
Difference from GLP-1 drugs and combination therapy
While GLP-1 receptor agonists act on the brain to suppress appetite, SGLT2 inhibitors do not affect appetite but rather excrete ingested sugar from the body. SGLT2 inhibitors alone do not reduce food intake.
In an overseas clinical trial (DURATION-8 trial), the group that combined GLP-1 receptor agonists (exenatide) and SGLT2 inhibitors (dapagliflozin) showed superior weight loss compared to groups receiving either monotherapy, and this difference was maintained at 52 weeks. Combining drugs with different mechanisms of action can be expected to produce greater effects.
However, when used in combination, the risk of hypoglycemia increases compared to monotherapy, so always use under the guidance of a physician.
Differences from other diet medications
| Type | How it works | Who it's for |
|---|---|---|
| SGLT2 inhibitors (daily) | Expels excess sugar in urine | Eats a lot of rice, noodles, and sweets |
| Metformin (daily) | Suppresses sugar production and improves insulin sensitivity | Wants to continue slowly and affordably |
| Xenical (with each meal) | Suppresses fat absorption | Eats a lot of fried or fatty foods |
| Rybelsus / Mounjaro | Suppresses appetite and prolongs satiety | Wants to suppress appetite itself and lose a significant amount of weight |
As a medication that moderates sugar absorption, voglibose is also an option. It is a drug that slows the rise in blood sugar levels after meals and may be used for those who consume a lot of carbohydrates. Since its mechanism of action is different, combination with metformin or SGLT2 inhibitors may be considered. Please consult with your doctor during the examination if you are interested.
How to take
- Typically, take 1 tablet once daily, either before or after breakfast.
- Due to its diuretic effect, taking it at night may disrupt sleep due to nocturnal urination. Taking it in the morning is generally recommended.
- If you miss a dose, do not take two doses at once; return to your usual schedule the next morning.
- Be sure to drink more water than usual while taking this medication.
Our clinic also suggests using SGLT2 inhibitors as an add-on on days when you plan to consume a lot of carbohydrates, while normally controlling appetite with GLP-1 drugs. Combining them in crucial situations can also be effective for preventing rebound.
Cost and Prescription Process
6,400 yen (tax included, shipping and consultation fees included). No additional consultation or shipping fees. As this is out-of-pocket medical care, health insurance does not apply.
| STEP | Content |
|---|---|
| 1. Order & Pre-consultation | Choose your desired plan and place an order. You will then fill out a pre-consultation form regarding your symptoms and medical history. Please accurately report any existing medical conditions and medications you are currently taking. |
| 2. Online Consultation | A doctor will assess the suitability of prescription and medication via video call. You can receive the consultation with just a smartphone or PC. |
| 3. Shipping | Same-day shipping available. Delivered in discreet packaging. |
You can start today.
About side effects
| Side Effect | Reason for Occurrence | Guidance for Action |
|---|---|---|
| Urinary tract infection / Genital infection | Increased sugar in urine makes it easier for bacteria/fungi to proliferate (especially for women) | Drink plenty of fluids and keep the genital area clean. Contact us immediately if you experience painful urination, frequent urination, or fever. |
| Dehydration | Due to increased urine volume | If you experience dry mouth or fatigue, rehydrate. Consult us if it doesn't improve. |
| Euglycemic diabetic ketoacidosis (rare) | When sugar excretion and energy deficit combine | If you experience nausea, vomiting, abdominal pain, or severe weakness, stop taking the medication and seek medical attention immediately. |
| Hypoglycemia | When used concomitantly with other diabetes medications (especially insulin or SU drugs) | Always disclose any concomitant medications. |
To prevent urinary tract infections and dehydration
- Drink more water than usual to avoid concentrated urine.
- Keep the genital area clean.
- Contact us promptly if you experience symptoms such as painful urination, frequent urination, or fever.
Situations requiring particular caution during medication (Sick Day)
During periods of illness (sick days) with fever, diarrhea, or vomiting, when food intake is insufficient, the risk of dehydration and ketoacidosis increases. Do not continue taking the medication on your own; always suspend its use. Drink fluids and resume medication once your condition improves. Similar caution is required during periods of extreme carbohydrate restriction.
Who should avoid using this product?
- Those with a history of allergy to any component of SGLT2 inhibitors.
- Those with diabetic coma or pre-coma.
- Those with severe infections.
- Those with large injuries, such as before or after surgery.
- Those who are pregnant or breastfeeding.
Who should use this product with caution?
- Elderly individuals (due to increased risk of dehydration and hypoglycemia)
- Individuals who consume a lot of alcohol
- Individuals who frequently experience urinary tract infections or genital infections
- Individuals using other diabetes medications such as insulin or SU drugs
- Individuals with impaired kidney function
Information on off-label use and private medical care
- Approval status: SGLT2 inhibitors are approved in Japan as a medication for diabetes treatment. Their use for weight management in individuals without diabetes is considered off-label use.
- Procurement method: We use domestically approved products sourced through domestic pharmaceutical wholesalers. These are not individually imported products.
- Cost: Since it is off-label use, health insurance does not apply, and the full cost is borne by the patient (private medical care).
- Risks: In cases of off-label use, the Pharmaceutical Adverse Reaction Relief System may not apply if side effects occur. Please refer to the above information regarding side effects.
- Effectiveness: The degree of effectiveness varies among individuals, and not everyone will achieve the same results.
Frequently Asked Questions
Related Pages
- Metformin (Supports sugar metabolism)
- Xenical (Fat cutter)
- Mounjaro (GLP-1/GIP injection)
- Rybelsus / Ozempic (GLP-1)
- Bofutsushosan (Improves bowel movements)
- About Online Consultation / About Pricing
References
- Ferrannini G, et al. Energy Balance After Sodium-Glucose Cotransporter 2 Inhibition. Diabetes Care. 2015;38(9):1730-1735.
- Bolinder J, et al. Effects of Dapagliflozin on Body Weight, Total Fat Mass, and Regional Adipose Tissue Distribution in Patients with Type 2 Diabetes Mellitus with Inadequate Glycemic Control on Metformin. J Clin Endocrinol Metab. 2012;97(3):1020-1031.
- Jabbour SA, et al. Efficacy and Safety Over 2 Years of Exenatide Plus Dapagliflozin in the DURATION-8 Study. Diabetes Care. 2020.
