• Toshihiro Higashikawa, Tomohiko Ito, Takurou Mizuno, Keiichirou Ishigami, Kengo Kuroki, Naoto Maekawa, Daisuke Usuda, Takuro Morita, Kazu Hamada, Susumu Takagi, Kento Takeshima, Shinya Yamada, Ryusho Sangen, Toshihide Izumida, Hideyuki Mori, Jun Kiyosawa, Atsushi Saito, Masaharu Iguchi, Takeshi Nakahashi, Yuji Kasamaki, Akihiro Fukuda, Tsugiyasu Kanda, and Masashi Okuro.
• Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan.
• Medicine (Baltimore). 2021 Nov 12; 100 (45): e27638e27638.

AbstractAdrenocorticotropic hormone (ACTH) and cortisol reportedly play a role in glycemic control in patients with type 2 diabetes mellitus (T2DM); however, the underlying mechanism remains controversial. We retrospectively investigated the effect of tofogliflozin on serum ACTH and cortisol levels in elderly patients with T2DM.Patients received 20 mg tofogliflozin daily for 3 months. Serum ACTH and cortisol levels were measured at baseline, as well as after 1 month and 3 months of tofogliflozin therapy.Serum ACTH levels were significantly reduced 3 months after tofogliflozin treatment (P < .01). Additionally, serum cortisol levels were reduced 3 months after tofogliflozin treatment, demonstrating borderline significance (P = .05). The higher body mass index (BMI; ≥25 kg/m2) group showed higher ACTH and cortisol levels than the lower BMI (<25 kg/m2) group, with borderline significance (P = .05). Renin levels were significantly increased 1 month after treatment (P < .05), maintaining serum aldosterone levels in parallel with the extracellular fluid.Our findings suggested that tofogliflozin decreased both serum ACTH and cortisol levels, with higher levels observed in the high BMI group. Tofogliflozin increased serum renin levels while maintaining serum aldosterone and extracellular fluid levels. Collectively, tofogliflozin could affect the hypothalamic-pituitary-adrenal pathway in patients with T2DM, especially in the low BMI group.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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