Table 2. Clinical recommendations on the use of SGLT-2 inhibitors for the management of Asian patients with T2DM and abdominal obesity.

Clinical recommendations
Overweight/obesity burden and associated complications in Asian patients with T2DM
• Overweight/obesity is a major driver of the increasing prevalence of T2DM in Asia, and most of the patients with T2DM are overweight/ obese.
• Asian populations have higher abdominal adiposity for any given BMI compared with their Caucasian counterparts.
• Visceral or abdominal adiposity is strongly associated with risk of adverse CV outcomes and has been shown to be superior to BMI in predicting CVD risk.
• Overweight/obesity in patients with T2DM independently increases the risk of hypertension, dyslipidemia, and CHD; it is also associated with other complications such as ectopic fat deposition (e.g., NAFLD).
Weight loss as an essential management goal in overweight/obese patients with T2DM
• Weight loss is an important management goal in patients with T2DM, who are overweight/obese.
• Lifestyle modification (diet, physical activity, and behavioral therapy) designed to achieve and maintain weight loss should be prescribed for patients with T2DM who are overweight/obese.
• Limited glucose-lowering pharmacological therapies are available that promote weight loss in T2DM.
• In overweight/obese patients with T2DM, use of glucose-lowering medications that promote weight loss or are weight neutral is recommended.
∘ Use of medications that are associated with weight gain should be minimized in overweight/obese patients with T2DM.
Role of SGLT-2 inhibitors in the management of Asian patients with T2DM and abdominal obesity
• SGLT-2 inhibitor is recommended to promote weight loss and reduction in visceral adiposity in Asian patients with T2DM and abdominal obesity.
• SGLT-2 inhibitors promote weight loss in Asian patients with T2DM as monotherapy or in combination with other GLDs.
∘ More than two-thirds of SGLT-2 inhibitor-induced weight loss is attributable to a reduction in body fat mass.
• SGLT-2 inhibitor treatment reduces WC (a measure of abdominal or visceral adiposity) and ectopic fat deposition in non-adipose tissues, and improves adipose tissue function, HRQoL, and patient-reported treatment satisfaction.

SGLT-2, sodium glucose cotransporter-2; T2DM, type 2 diabetes mellitus; BMI, body mass index; CV, cardiovascular; CVD, cardiovascular disease; CHD, coronary heart disease; NAFLD, non-alcoholic fatty liver disease; GLD, glucose-lowering drug; WC, waist circumference; HRQoL, health-related quality of life.