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AACE: Dapagliflozin Reduces Postprandial Glucose in Type 2 Diabetes

Dapagliflozin as an add-on therapy to glimepiride, pioglitazone, or sitagliptin significantly reduces postprandial plasma glucose in type 2 diabetes patients…. 

The US Food and Drug Administration approved dapagliflozin on January 8, 2014, for use in glycemic control, along with diet and exercise, in adults with type 2 diabetes.

Dapagliflozin, a sodium glucose cotransporter 2 (SGLT2) inhibitor, lowers plasma glucose concentration by increasing renal glucose excretion, independent from insulin secretion.

The authors point out that control of fasting hyperglycemia alone may not be optimal for achieving long term glucose control, as indicated by HbA1c <7.0%, in patients with type 2 diabetes mellitus (T2DM). The current study evaluated postprandial glucose.

In three phase 3 randomized trials, type 2 diabetes patients received 10 mg/day dapagliflozin or placebo as an add-on therapy to glimepiride (n=596), pioglitazone (n=420) and sitagliptin with or without metformin (n=451).

The study showed that the addition of dapagliflozin significantly reduced postprandial plasma glucose compared with placebo: placebo-corrected mean changes from baseline at 24 weeks in 2-hour postprandial plasma glucose for dapagliflozin were -49.1 (-64.1, -34.1) mg/dL with glimepiride, -53.3 (-71.1, -35.6) mg/dL with pioglitazone, and -42.9 (-52.1, -33.8) mg/dL with sitagliptin.

According to the authors, “Observational studies suggest that postprandial glucose may be more predictive of cardiovascular morbidity and mortality and microvascular complications than fasting plasma glucose.

“Higher postprandial blood glucose concentrations may lead to increased glucose filtration, allowing for greater glucose excretion with SGLT2 inhibition and effective postprandial glucose lowering, thus potentially preventing vascular complications,” the authors write.

Practice Pearls:
  • The addition of dapagliflozin significantly reduced postprandial plasma glucose compared with placebo
  • PPG may be more predictive of cardiovascular morbidity and mortality and microvascular complications than fasting plasma glucose.
  • The number of adverse events was similar for dapagliflozin and placebo.

The study was presented at the American Association of Clinical Endocrinologists annual meeting held from May 14th to 18th in Las Vegas, Nevada.