SGLT2 Inhibitors for Weight Loss | Effects and Side Effects | Online Prescription - Mona Clinic

What are SGLT2 inhibitors? How they work to reduce weight by "expelling" sugar, and how to choose your medication

When you hear "medical weight loss," you might feel suspicious or worried about safety. In reality, it's a highly safe method where, under medical supervision, medication allows you to naturally lose weight without excessive dietary restrictions or intense exercise.

Mona Clinic offers online consultations for SGLT2 inhibitors, with treatments delivered to your home with same-day shipping possible.

Types of Medical Weight Loss and the Role of SGLT2 Inhibitors

Medications used for medical weight loss are broadly divided into "oral medications" and "injectable medications," with common examples being GLP-1 receptor agonists, SGLT2 inhibitors, and herbal medicines. GLP-1 drugs (also known as "weight-loss hormones") work by acting on the brain's satiety center to suppress appetite itself. However, SGLT2 inhibitors, which are explained on this page, work through a completely different mechanism: they support weight loss not by suppressing appetite, but by "expelling ingested sugar from the body along with urine."

What are SGLT2 Inhibitors?

SGLT2 (Sodium-Glucose Cotransporter 2) is a protein found in the renal tubules of the kidneys that reabsorbs glucose into the bloodstream that would otherwise be excreted in urine. SGLT2 inhibitors intentionally hinder this reabsorption process, thereby excreting excess sugar from the body with urine, lowering blood sugar levels, and supporting weight loss. Originally developed as a treatment for type 2 diabetes, these drugs have a proven track record and have been widely used in insured medical care.

Differences between SGLT2 and SGLT1, and key points for choosing medication

About 90% of glucose flowing into the kidneys is reabsorbed into the bloodstream by SGLT2, and the remaining approximately 10% by SGLT1. SGLT1 has a stronger ability to draw in sugar than SGLT2, and it is also widely distributed not only in the kidneys but also in the small intestine, heart, and brain. Among SGLT2 inhibitors, some drugs have high selectivity for SGLT2 (e.g., Lusefi, Forxiga), while others have low selectivity and also act on SGLT1 (e.g., Canaglu, Suglat). This difference is a key point in choosing medication.

List and Comparison of Medications

All medications are generally taken once a day, before or after breakfast. Some drugs, such as Forxiga, are also recommended in heart failure treatment guidelines and are gaining attention from perspectives other than diabetes treatment.

Expected Diet Effects

The action of SGLT2 inhibitors is estimated to excrete approximately 200-400 kcal of glucose into the urine per day. This amounts to about 6,000-12,000 kcal per month, and since 1 kg of fat is approximately 7,000 kcal, a weight loss of around 1 kg per month can be expected. Overseas clinical studies have reported that when dapagliflozin (Forxiga) was added to metformin in patients with type 2 diabetes, a significant weight reduction was observed compared to metformin alone, with most of it being fat reduction.

Differences from GLP-1 drugs and their combination

While GLP-1 receptor agonists act on the brain to suppress appetite itself, SGLT2 inhibitors do not suppress appetite; they work through a different mechanism by directly expelling ingested sugar from the body. Therefore, SGLT2 inhibitors alone do not reduce the amount of food consumed.

In an overseas clinical trial (DURATION-8 study), a group combining a GLP-1 receptor agonist (exenatide) and an SGLT2 inhibitor (dapagliflozin) showed superior weight loss effects compared to groups using either monotherapy, and this difference was maintained at 52 weeks. Combining drugs with different mechanisms of action may lead to higher efficacy.

When combining GLP-1 drugs and SGLT2 inhibitors, the risk of hypoglycemia is said to increase compared to single use, so always use them under the supervision of a doctor.

How to Take

The basic dosage is one tablet once a day. At our clinic, we also suggest a way to use it where you control your appetite with GLP-1 drugs normally, and add SGLT2 inhibitors on days when you plan to consume a lot of carbohydrates. Combining SGLT2 inhibitors strategically can also help prevent rebound weight gain.

Side Effects

• Urinary tract infections and genital infections (because increased sugar in urine makes it easier for bacteria and fungi to proliferate, especially women need to be careful)

• Dehydration (increased urine output can cause symptoms like dry mouth and fatigue)

• Nausea, vomiting, abdominal pain, weakness (rarely, euglycemic ketoacidosis may occur)

• Hypoglycemia (caution is needed when used with other diabetes medications, especially insulin or sulfonylureas)

To prevent urinary tract infections and dehydration

• Consciously drink more water than usual to prevent urine from becoming too concentrated.

• Keep the genital area clean.

• If you experience symptoms such as painful urination, frequent urination, or fever, please contact us promptly.

Situations requiring special attention during use (sick days)

If you are feeling unwell (sick day) with fever, diarrhea, vomiting, or insufficient food intake, please discontinue the medication without self-judgment, as the risk of dehydration and ketoacidosis increases.

Those who should avoid use

• Individuals with a history of allergy to SGLT2 inhibitor ingredients

• Individuals with diabetic coma or pre-coma

• Individuals with severe infections

• Individuals with major trauma, such as before or after surgery

• Pregnant or breastfeeding individuals

Those who should use with caution

• Elderly individuals (due to increased risk of dehydration and hypoglycemia)

• Individuals who consume a lot of alcohol

• Individuals prone to recurrent urinary tract infections or genital infections

• Individuals using other diabetes medications, such as insulin or sulfonylureas

Online Treatment Process

• ① Temporary payment & pre-medical questionnaire: Select your desired plan and place an order.

• ② Online consultation: A doctor will confirm suitability via video call, and you can also discuss combining with GLP-1 drugs.

• ③ Same-day shipping possible

• ④ Follow-up progress with regular consultations

References

• 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.