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J Obes Metab Syndr 2018;27:1-3 Obesity has been associated with diabetes incidence and complications. In South Korea, the mean body mass index (BMI) of diabetic subjects has gradually increased, and the proportion of obesity (BMI ≥ 25 kg/m2) and abdominal obesity are 48.6% and 58.9%, respectively.1 The first line treatment of obesity is a combination of a low calorie diet, increased physical activity, and behavioral therapy. However, it is very difficult for obese subjects to reduce and maintain their weight by life-style modification alone. Several kinds of newly developed antidiabetic medications showed useful advantages in obese diabetic patients. Such patients show not only reduced hypoglycemia, but also moderate effects of weight reduction and decrease in blood pressure. Cho et al.2 retrospectively investigated the effect of dapagliflozin on body weight reduction in Korean subjects with type 2 diabetes mellitus (T2DM). Although the study had no control group, metformin based-combination treatment of dapagliflozin with other classes of oral hypoglycemic agents in Korean patients with T2DM showed comparable efficacy of body weight reduction, blood pressure lowering, and antihyperglycemic effects to a previous report3 and few adverse events. However, the number of subjects was too small for further subgroup analyses with stratification of baseline anthropometry or laboratory findings. Because many patients with T2DM are overweight/obese and/or have hypertension, weight loss and blood pressure reduction are important components of T2DM management as well as achieving glycemic control. The prescription of sodium-glucose co-transporter 2 inhibitor (SGLT2i) has steadily increased in Korea due to various advantages in T2DM and is eligible for national health insurance coverage. Moreover, much more use is expected since empagliflozin and canagliflozin have shown beneficial cardiovascular effects in high cardiovascular risk patients in the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose Study4 and the Canagliflozin Cardiovascular Assessment Study.5 Currently available SGLT2is in South Korea are dapagliflozin, empagliflozin, and ipragliflozin. All of these inhibit SGLT2 and thereby reduce renal tubular glucose reabsorption, resulting in increased glycosuria. SGLT2i induces weight reduction through a negative caloric balance and blood pressure reduction caused by natriuresis. However, SGLT2i-associated weight loss is less than the amount predicted based on urinary glucose excretion.6 This might be due to the role of SGLT1 upregulation in renal reabsorption of

Sodium-Glucose Co-transporter 2 Inhibitor: The Magic Bullet for Obesity in Diabetes?