Poster Presentation The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2017

Sustained, successful treatment of diabetes in lipodystrophy by dapagliflozin  (#237)

Thomas J Ulahannan 1 , Michael D'Emden 2
  1. Friendly Society Private Hospital, Bundaberg, QLD, Australia
  2. Department of Endocrinology and Diabetes, Royal Brisbane Hospital, Brisbane, Queensland, Australia

A 59 year old lady presented with the recent development of weight loss and hyperglycaemia associated with severe hyperlipidaemia and insulin resistance in June 2014. She was of normal body weight with generalised loss of subcutaneous fat.  Investigations confirmed diabetes mellitus and severe hypertriglyceridaemia with high circulating insulin and proinsulin levels.  The lack of subcutaneous fat was confirmed by densitometry and CT scan.; her fat stored reported to be less than 5%.  She was diagnosed with acquired generalised lipodystrophy.   Her diabetes became difficult to control on metformin and gliclazide with her HbA1c increasing to 9.2% by December 2014.  Insulin therapy was considered but a trial of dapagliflozin (an SGLT2 inhibitor) was undertaken. Within a short period, glucose control improved with normalisation of lipid levels. The patient developed no significant side effects. The improved glucose and lipids levels has been sustained for three years; her HbA1c being 6.3% in December, 2016 on metformin and dapagliflozin therapy only. To our knowledge, this is the first report of SGLT2 inhibition in diabetes associated with lipodystrophy and suggests an alternative therapeutic strategy. The ability of SGLT2 inhibition to achieve sustained improvement of glucose levels perhaps through glycosuria suggests specific benefits of this therapeutic approach, perhaps by depleting ectopic fat stores, improving insulin resistance.  It is possible that long term complications of the syndrome such as acanthosis nigricans mediated through insulin resistance, may be ameliorated.

In summary, we describe a novel approach to the treatment of a patient having diabetes associated with acquired generalised lipodystrophy. The response of this patient suggests that SGLT2 inhibitors are a therapeutic option in these rare patients who can represent a major therapeutic challenge. Further studies are required to confirm their efficacy in this condition and to determine if these agents have specific benefits in these patients.