Diabetes: early vs later dapagliflozin intensification

  • P H Wilding J & al.
  • Diabetes Res Clin Pract
  • 17 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes mellitus (T2DM), early intensification of dapagliflozin may be associated with greater glycaemic benefits compared with later intensification.
  • No significant difference was observed in weight and systolic blood pressure (SBP) between early and later dapagliflozin users.

Why this matters

  • Recent T2DM guidelines recommend early intensification with sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide-1 receptor agonist that have shown cardiovascular (CV) benefits in patients with a history of established atherosclerotic CV disease or chronic kidney disease.

Study design

  • 3774 patients with T2DM (age, ≥18 years), initiated dapagliflozin between November 2012 and August 2016, were included from the UK Clinical Practice Research Datalink (CPRD).
  • Primary outcomes: changes in glycated haemoglobin (HbA1c) level, weight, and SBP with early vs later dapagliflozin intensification.
  • Funding: AstraZeneca.

Key results

  • Of 3774 patients, 951 (25%) were early and 2823 (75%) were later users of dapagliflozin.
  • After adjustment for confounders, early vs later dapagliflozin use was associated with a greater likelihood of ≥1% HbA1c reduction (OR, 1.68; 95% CI, 1.15-2.45; P=.0073).
  • Patients aged >70 years vs those aged
  • Patients with a lower baseline HbA1c level (10.0%; OR, 0.08; 95% CI, 0.06-0.10; P<.0001>
  • Early vs later dapagliflozin users did not differ in weight (OR, 0.79; 95% CI, 0.54-1.14; P=.2079) and SBP (OR, 0.87; 95% CI, 0.58-1.30; P=.4870).

Limitations

  • Study did not assess the efficacy of early intensification with dapagliflozin vs other T2DM therapies.