Endocrine Abstracts

Background: Dapagliflozin was the first SGLT2 inhibitor licensed in UK to improve glycaemic control in type 2 diabetes. The study aimed to assess impact of dapagliflozin on glucose, weight and BP and identify factors predictive of glycaemic response in a large cohort.

Methods: Observational retrospective data collected on all patients prescribed dapagliflozin across primary and secondary care in two Scottish health board areas. HbA1c, weight, BP and concomitant therapy pre and post initiation of therapy and rate of and reasons for discontinuation of therapy were extracted from electronic patient records (SCI-diabetes). HbA1c response by intention to treat was investigated compared to baseline for subgroups by concomitant treatment, baseline BMI and baseline HbA1c. Weight and BP change at 12 months were compared to baseline.

Results: Five hundred and ninty seven patients were included and 521 had follow up data available. 36 patients (6%) discontinued treatment. HbA1c (mmol/mol) at initiation was 80 (IQR 67–94) and at 6,12, and 24 months were 68 (57–76.5), 66 (56–78) and 66.5 (57–76) (P≤0.001). Baseline Systolic BP was 136 mmHg (IQR 124–146) and at 12 months was 131 mmHg (120–142) Baseline diastolic BP was 80 mmHg (72–84) and at 12 month 77 mmHg (70–82) (P≤0.001). Complete weight data at baseline and 12 months was available in 181 patients and was 100.3 kg (IQR 88–118.1) at baseline reducing to 97 kg (IQR 84.4–114) at 12 months (P=0.07). Glucose lowering efficacy was seen in patients treated with concomitant insulin, GLP-1 and dual and triple oral therapy. Glycaemic reduction was greater in patient group with higher baseline HbA1c. Significant reduction in HbA1c from baseline was seen across all BMI ranges.

Conclusions: In a large cohort Dapagliflozin effectively reduces HbA1c, weight and BP. As predicted by the mode of action by SGLT2 inhibition, glycaemic efficacy is independent of concomitant therapy type and patient phenotype.