Dapagliflozin – a sodium-glucose co transport-2 (SGLT2) inhibitor has recently been introduced into clinical use for type 2 diabetes (T2DM) in Australia. We conducted an audit of patients attending General Practice and Blacktown Hospital Outpatient clinics who commenced dapagliflozin and followed up 3-6 months later.
To monitor trends in T2DM control before and 3-6 months after introduction of dapagliflozin and reasons for discontinuation.
98 Patients commencing dapagliflozin were identified from the outpatient clinics and GP case conference sessions. Clinic databases were used to collect patient demographic and clinical data: HbA1c, weight and blood pressure (BP). Multilevel linear regression was used to analyse change in each variable (adjusting for age and gender). Reasons for discontinuation of dapagliflozin were recorded.
Before dapagliflozin, mean HbA1c concentration was 9.1% (95% CI 8.6 to 9.7), weight 102.9kg (93.7 - 111.0), systolic BP 133.0 mmHg (127.9 to 138.1) and diastolic BP 81.3 mmHg (77.7 to 85.0). Mean change after introduction of dapagliflozin was -1.1% for HbA1c (-1.6 to -0.6, p<0.001), -2.6kg for weight (-4.0 to -1.1, p=0.001), -4.3mmHg for systolic BP(-9.5 to 0.9, p=0.104) and -2.9mmHg for diastolic BP(-6.5 to 0.8, p=0.121).
At 3-6 months follow-up, 10 patients had ceased dapagliflozin. Reasons included rash (n=1), nausea (n=2), possible candidiasis (n=1),urinary tract infection (n=1),urinary frequency/nocturia (n=3), non-compliance (n=2) and renal impairment (n=2). Euglycaemic ketoacidosis was not observed.
Clinically meaningful reductions in HbA1c, weight and, potentially, BP, were observed following the introduction of dapagliflozin. These findings support the use of dapagliflozin as a second-line or third line oral hypoglycaemic agent. Discontinuation occurred in 10% of patients, for various reasons;a similar rate in real-life as that reported in clinical trials.