ADA 2020 — Dapagliflozin lowers risk of new-onset type 2 diabetes in patients with heart failure


  • Sarfaroj Khan
  • Conference Reports
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Takeaway

  • This new analysis of the DAPA-HF trial suggests that sodium-glucose cotransporter 2 inhibitor dapagliflozin reduces the relative incidence of new-onset type 2 diabetes (T2D) by almost a third in patients with heart failure with reduced ejection fraction (HFrEF).
  • Daily treatment reduces the risk by 32%.

Why this matters

  • Findings indicate that diabetes prevention could be considered an additional benefit of dapagliflozin, whose main effect is to lower cardiovascular mortality and worsening of heart failure in patients with HFrEF.

Study design

  • DAPA-HF was a phase 3 placebo-controlled trial involving 4744 patients with HFrEF.
  • This exploratory analysis of DAPA-HF evaluated whether dapagliflozin reduced T2D incidence in 2605 trial patients without T2D.
  • Patients were randomly assigned to receive dapagliflozin 10 mg (n=1298) or placebo (n=1307) and followed for a median of 18.2 months.
  • New-onset T2D was defined as glycated hemoglobin (HbA1C) of ≥6.5% on 2 consecutive study visits.
  • Funding: AstraZeneca.

Key results

  • A total of 157 patients developed T2D, of whom 150 (95.5%) had prediabetes (HbA1C, 5.7%-6.4%).
  • Patients who developed T2D vs those who remained nondiabetic had a higher:
    • mean baseline HbA1C (6.2±0.3 vs 5.7±0.4%; P<.001>
    • greater body mass index (28.5±5.9 vs 27.1±5.7 kg/m2; P=.003); and
    • lower estimated glomerular filtration rate (61.5±17.4 vs 68.2±19.3 mL/min/1.73 m2; P<.001>
  • Cox proportional hazards model revealed that dapagliflozin reduced new-onset T2D by 32% (HR, 0.68; 95% CI, 0.50-0.94; P=.019); 64 (4.9%) patients developed T2D in the dapagliflozin vs 93 (7.1%) in the placebo group.
  • Patients who developed T2D during the trial had a statistically significant 70% increased incidence of all-cause mortality.

Limitations

  • Short follow-up duration.