Use and effectiveness of dapagliflozin in patients with type 2 diabetes mellitus: a multicenter retrospective study in Taiwan

Abstract

Aims/Introduction To investigate the clinical outcomes of patients with type 2 diabetes mellitus (T2DM) who initiated dapagliflozin in real-world practice in Taiwan. Materials and Methods In this multicenter retrospective study, adult patients with T2DM who initiated dapagliflozin after May 1st 2016 either as add-on or switch therapy were included. Changes in clinical and laboratory parameters were evaluated at 3 and 6 months. Baseline factors associated with dapagliflozin response in glycated hemoglobin (HbA1c) were analyzed by univariate and multivariate logistic regression. Results A total of 1,960 patients were eligible. At 6 months, significant changes were observed: HbA1c by −0.73% (95% confidence interval [CI] −0.80, −0.67), body weight was -1.61 kg (95% CI −1.79, −1.42), and systolic/diastolic blood pressure by −3.6/−1.4 mmHg. Add-on dapagliflozin showed significantly greater HbA1c reduction (−0.82%) than switched therapy (−0.66%) (p = 0.002). The proportion of patients achieving HbA1c <7% target increased from 6% at baseline to 19% at Month 6. Almost 80% of patients experienced at least 1% reduction in HbA1c, and 65% of patients showed both weight loss and reduction in HbA1c. Around 37% of patients had at least 3% weight loss. Multivariate logistic regression analysis indicated patients with higher baseline HbA1c and those who initiated dapagliflozin as add-on therapy were associated with a greater reduction in HbA1c. Conclusions In this real-world study with the highest patient number of Chinese population to date, the use of dapagliflozin was associated with significant improvement in glycemic control, body weight, and blood pressure in patients with T2DM. Initiating dapagliflozin as add-on therapy showed better glycemic control than as switch therapy.

Treatment effect heterogeneity following type 2 diabetes treatment with GLP1-receptor agonists and SGLT2-inhibitors: a systematic review

“…SGLT2i: Lesser glycaemic response for renally impaired patients and those with lower baseline kidney function (eGFR). BMI 15 37 – 41 , 45 , 48 , 54 , 57 , 58 , 61 , 62 , 140 , 142 , 143 11 32 , 44 , 46 , 56 , 59 , 60 , 63 , 147 , 148 , 153 , 154 0 4 21 , 24 , 150 , 151 2 27 , 32 2 22 , 26 No consistent evidence of significant modifying effects of BMI on glycaemic response for either SGLT2i or GLP1-RA. Age 13 37 – 41 , 45 , 47 , 54 , 61 , 62 , 140 , 142 , 143 7 32 , 44 , 46 , 59 , 63 , 148 , 155 0 4 …”

“…GLP1-RA: Longer diabetes duration (or proxies such as insulin treatment) associated with lesser glycaemic response. Sex 13 37 – 41 , 45 , 48 , 54 , 55 , 62 , 140 , 142 , 143 6 32 , 46 , 50 , 56 , 59 , 63 0 4 24 , 30 , 150 , 151 1 32 3 22 , 26 , 156 No consistent evidence of significant modifying effects of sex on glycaemic response for either SGLT2i or GLP1-RA. Ethnicity 2 40 , 67 5 32 , 59 , 63 , 65 , 68 1 66 1 30 1 32 4 15 , 26 , 28 , 29 No consistent evidence of differences in glycaemic response across ethnic groups for either SGLT2i or GLP1-RA.…”

Precision medicine in type 2 diabetes: A systematic review of treatment effect heterogeneity for GLP1-receptor agonists and SGLT2-inhibitors

“…A further finding confirmed by multiple robust studies is that in keeping with other glucose-lowering agents higher baseline HbA1c is associated with greater HbA1c lowering with SGLT2 inhibitors, including verses placebo 12,18,[20][21][22][23][24] . Active comparator studies suggested that higher baseline HbA1c may predict greater relative HbA1c response to SGLT2i therapy in comparison to DPP4i and sulfonylurea therapy 12,22,23 .…”

Effects of dapagliflozin compared with glimepiride on body composition in Asian patients with type 2 diabetes inadequately controlled with metformin: The BEYOND study

“…Data from previous clinical trials have reported that dapagliflozin leads to reduced BF and weight loss – either as monotherapy, or in combination with other medications such as metformin, glimepiride, or insulin 13–16 . Real‐world studies from both developed and developing countries have also substantiated the benefit of dapagliflozin for weight loss in patients with T2D 26–29 . However, the unique phenotype of the Asian population constituting higher BF at lower BMI makes it imperative to crystallize the implications of dapagliflozin, specifically with respect to the total BF mass and total BF%.…”

“…[13][14][15][16] Realworld studies from both developed and developing countries have also substantiated the benefit of dapagliflozin for weight loss in patients with T2D. [26][27][28][29] However, the unique phenotype of the Asian population constituting higher BF at lower BMI makes it imperative to crystallize the implications of dapagliflozin, specifically with respect to the total BF mass and total BF%. The results of our study in the Korean population affirms the multi-pronged approach of dapagliflozin on body composition, even in characteristic 'thin-fat' phenotypes.…”