Home / Therapies / Blood Glucose Control / Adding An SGLT-2 Earlier To A Treatment Plan Yields Positive A1c Levels 

Adding An SGLT-2 Earlier To A Treatment Plan Yields Positive A1c Levels 

Sep 22, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Joel John, Pharm.D. Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

If dapagliflozin is prescribed early — as the second medication after the first-line treatments of metformin or sulfonylurea — it has a greater impact. 

 Even after people with type 2 diabetes make necessary lifestyle changes and adopt a treatment regimen, it will still take time to see a difference in their HbA1c. Sometimes, people will change their diabetes treatment 3-4 times before finding a treatment plan that effectively lowers their HbA1c. Sodium-glucose cotransport-2 (SGLT2) inhibitors like dapagliflozin work by reducing the body’s resorption of glucose, and lower a person’s body weight as well.   

This study was a non-interventional retrospective cohort study that wanted to explore the idea that earlier initiation of dapagliflozin can reduce HbA1c more than if it is initiated later on in treatment. Those who took part in the study were observed for up to 15 months after starting dapagliflozin. The inclusion criteria for this study included patients who are at least 18 years old, dapagliflozin being initiated between November 2012 and August 2016, and have a confirmed diagnosis of type 2 diabetes before the start of the study. Patients included in the study also had to have been diagnosed with type 2 diabetes for at least 12 months before the study, use metformin or a sulfonylurea as initial therapy, and use dapagliflozin at least six months with a 6-month follow-up period as well. One of the exclusion criteria for this study included a confirmed diagnosis of type 1 or gestational diabetes. Patients in this study were also excluded from using injectable therapy for their diabetes, such as insulin or a GLP-1 agonist. To determine if someone was considered an early user of dapagliflozin or not, it had to be the second medication prescribed to the patient after the first-line treatments of metformin or sulfonylurea. Patients in the study were considered later users of dapagliflozin if another medicine was prescribed between one of the first-line therapies and dapagliflozin.   

Some of the primary outcomes measured in this study included changes in HbA1c, weight, and systolic blood pressure. These changes in measurements were compared between both groups to see if the actual transition took place based on when dapagliflozin was added.   

There were 3,774 patients in total included in the study. 951 of these patients were considered early dapagliflozin users, and 2,823 were considered later users. Some trends that were seen in the study were that the early users were typically younger, more likely to be women, and were diagnosed with type 2 diabetes for less time compared to the later dapagliflozin group.   

Patients in the first dapagliflozin group experienced a mean HbA1c reduction of 1.6% vs. the later  group, who had a mean HbA1c reduction of 1.0%. Early dapagliflozin patients who were older than 70 years old were less likely to experience the same level of HbA1c reduction compared to those who were less than 55 years old. The study did show that there was no difference between the two groups when it came to decreases in weight and systolic blood pressure.   

There is still more research that needs to be conducted to assess whether early dapagliflozin use can help improve glycemic control in those who do not attain their glycemic goals with initial treatment; however, this study was a step in the right direction.   
 
Practice Pearls: 

  • The addition of dapagliflozin can show increased changes in HbA1c in those who have not met their glycemic goals from firstline therapy.   
  • This study further proved that adding dapagliflozin earlier in a treatment plan can show more significant benefits vs. adding it after trying other diabetes medications.   
  • A follow-up study needs to be initiated to validate the clinical advantages of this study and the risks associated with this change in treatment.   

 

Wilding, John P.h., et al. Glycaemic, Weight, and Blood Pressure Changes Associated with Early versus Later Treatment Intensification with Dapagliflozin in United Kingdom Primary Care Patients with Type 2 Diabetes Mellitus. Diabetes Research and Clinical Practice, vol. 155, 17 July 2019, p. 107791., doi:10.1016/j.diabres.2019.107791.  

 

Joel John, Pharm.D. Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

 

 

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