Dapagliflozin useful third-line therapy for Type 2 diabetes
MedWire News: The sodium–glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin stimulates further improvements in glycated hemoglobin (HbA1c) and weight loss in patients with Type 2 diabetes when added to a regimen of insulin and insulin-sensitizing drugs, research shows.
“Treatment of hyperglycemia in patients with Type 2 diabetes remains a challenge, particularly in those who require insulin as the disease progresses,” say John Wilding (University of Liverpool, UK) and team.
Various different combinations of insulin and oral diabetic agents have been tested, but often become less effective with time due to the degenerative nature of the disease.
In this study, Wilding and colleagues tested the efficacy of adding dapagliflozin (10 or 20 mg/day) versus placebo to a treatment regimen of oral antidiabetic drugs and 50% of the patient’s normal insulin for 12 weeks.
Of those who completed the study, 19 patients received placebo, 22 received dapagliflozin 10 mg/day, and 24 received dapagliflozin 20 mg/day.
At 12 weeks, those in the dapagliflozin 10- and 20-mg/day groups had reductions in HbA1c of 0.70% and 0.78%, respectively, compared with placebo. Overall, 65.2% of patients in the dapagliflozin groups achieved a decrease in HbA1c of 0.5% or more compared with just 15.8% of the placebo group.
Reduction in body weight at 12 weeks was also significantly greater in the dapagliflozin 10-mg/day and 20-mg/day groups compared with placebo, at 4.5 and 4.3 kg versus 1.9 kg, respectively.
Generally side effects were minimal and similar across all groups, but there were significantly more genital-tract infections in the dapagliflozin groups than placebo, especially in the dapagliflozin 20 mg/day group.
“Conclusions that can be drawn from this study are limited by its size and relatively short duration,” caution Wilding et al.
“Nevertheless, these results establish the proof of concept that SGLT2 inhibition can improve glycemic control and weight in patients with diabetes that is poorly controlled with high insulin doses and oral insulin sensitizer therapy, despite a 50% insulin dose reduction,” they conclude.
The results are published in the journal Diabetes Care.
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By Helen Albert