Comparative effectiveness of dapagliflozin vs DPP‐4 inhibitors on a composite endpoint of HbA1c, body weight and blood pressure reduction in the real world

Abstract

BackgroundTreatment of type 2 diabetes (T2D) should aim at preventing or delaying complications through the control of glycaemia and cardiovascular risk factors. We herein compared the SGLT‐2 inhibitor dapagliflozin vs DPP‐4 inhibitors (DPP‐4i) on a composite endpoint of glycaemic and extraglycaemic effectiveness.MethodsThis was a multicentre, retrospective real‐world study conducted at 56 outpatient clinics in Italy. We collected data on patients newly started on dapagliflozin or DPP‐4i in 2015‐2017. The primary endpoint was the proportion of patients attaining a simultaneous reduction of HbA1c ≥0.5%, body weight ≥2 kg, systolic blood pressure (SBP) ≥2 mmHg. Confounding by indication was addressed by propensity score matching (PSM) or multivariable adjustment (MVA).ResultsPatients initiating dapagliflozin (n = 2091) or DPP‐4i (n = 2144) differed for most clinical characteristics. After PSM, two well‐balanced groups of 1149 patients each were compared. The primary endpoint was reached in a greater proportion of patients who received dapagliflozin (17.6%) compared to DPP‐4i (11.7%), with a relative risk of 1.50 (1.21‐1.86; P < .001). Similar results were obtained in the as‐treated and intention‐to‐treat datasets or using MVA in place of PSM. The beneficial effect of dapagliflozin was mainly due to its greater effectiveness on body weight and, to a lesser extent, on SBP. The change in HbA1c did not differ between groups.ConclusionsT2D patients initiating the SGLT2i dapagliflozin had a greater probability of attaining a composite endpoint of clinically relevant reductions in HbA1c, body weight and SBP, compared to similar patients initiating a DPP‐4i in the same period and healthcare setting.

Cholesterol lowering therapies and achievement of targets for primary and secondary cardiovascular prevention in type 2 diabetes: unmet needs in a large population of outpatients at specialist clinics

“…Briefly, presence of coronary heart disease (CHD) was defined as a history of angina or myocardial infarction or coronary revascularization. Microangiopathy was defined as the presence of nephropathy, retinopathy/maculopathy or neuropathy, as defined in previous reports [ 10 , 11 ]. Previous cardiovascular disease (CVD) was defined as a history of stroke or myocardial infarction or any site revascularization.…”

“…Eventually, we evaluated the expected clinical benefit that would derive from such intensifications of LLT. As shown in Table 2, the clinical benefit, expressed as ARR or NNT to prevent one CVD events over 10 years, was 24 (19 -33) No 12 (11)(12)(13)(14) Total high risk n = 22,683; 26.3% progressively greater among those with higher CVD risk and higher LDL-c levels. This has been also depicted graphically in Fig.…”

The safety and efficacy evaluation of sodium-glucose co-transporter 2 inhibitors for patients with non-alcoholic fatty liver disease: An updated meta-analysis

“…The results of our meta-analysis showed that SGLT2i could significantly reduce BMI in patients with NAFLD [WMD: −0.84 kg/m 2 , 95% CI ( −1.09, −0.60)]. In a multi-centre, retrospective real-world study, patients with type 2 diabetes initiating SGLT2i dapagliflozin had a greater reduction in body weight than controls (pooled estimated treatment difference: −1.64 ±0.20 kg, p < 0.001) [39] . SGLT2i may be involved in the reduction of body weight through the water loss caused by osmotic diuresis, direct energy loss (20 0-30 0 kcal/day) and metabolism conversion, and the reduction of insulin dosage [40] .…”

Role of Glucose-Lowering Medications in Erectile Dysfunction

“…SGLT2is, also called gliflozins, represent another class of anti-hyperglycaemic agents currently used in T2D treatment; these medications are able to reduce hyperglycaemia (Hb1Ac reduction of −0.8 ± 1.4%) through the inhibition of glucose reabsorption in the proximal convoluted tubule of the kidney and the increase of glycosuria [ 170 , 171 , 172 ].…”

“…Large randomised trials of SGLT2is have shown reductions in cardiovascular events (particularly rates of hospitalisation for heart failure) in patients with T2D and in those with heart failure with reduced ejection fraction with or without diabetes [ 173 ]. Positive effects on body weight (−2.8 ± 4.9 kg) and the cardiovascular system manifest rapidly and, for this reason, are unlikely to be related only to the improvement in glycaemic control [ 172 ]. Indeed, SGLT-2i have also shown positive effects on multiple cardiovascular disease risk factors, including high blood pressure and obesity, as well as on serum uric acid and albuminuria levels [ 174 , 175 ].…”