The Effect of Dapagliflozin on Incidence of Diabetes

According to a recent study presented at the American Diabetes Association 80^th Scientific Sessions, the SGLT2 inhibitor dapagliflozin was shown to reduce incidence of worsening heart failure (HF) and cardiovascular death in 4744 patients with HF included in the study and reduced ejection fraction. Of these patients, 45% had type 2 diabetes (T2D) at baseline.

The goal of the study was to assess whether dapagliflozin reduced the incidence of diabetes in the 55% of patients without T2D. In order to accomplish this assessment, patients were randomized to take either dapagliflozin 10 mg or placebo over a duration of approximately 18.2 months.

For the study purposes, new-onset T2D was defined as A1c ≥6.5% based on measurements from 2 study visits post-randomization or investigator-reported new T2D. A Cox proportional hazards model was then used to assess the effect of dapagliflozin on T2D, with a Fine and Gray competing risk model used to confirm the assessment in order to account for mortality.

Of the 2605 patients who did not have T2D at baseline, 157 developed T2D during the trial. One-hundred fifty of these 157 patients (95.5%) had prediabetes. Furthermore, the patients with incident T2D had a higher mean baseline A1c and lower eGFR than those who continued to be nondiabetic.

The results of the study demonstrated that dapagliflozin was able to reduce new-onset diabetes by 32%, with these results confirmed by the Fine and Gray model based on the virtually identical results from both models. For this reason, the researchers noted that based on their research, the prevention of diabetes may be another benefit of dapagliflozin.

REFERENCE

Inzucchi SE, Kober L, Kosiborod MN. ADA Presidents' Select Abstract: Effect of Dapagliflozin on the Incidence of Diabetes: A Prespecified Exploratory Analysis from DAPA-HF. In: American Diabetes Association 80^th Scientific Sessions; June 12-16, 2020; virtual. Abstract 271-OR.