Glycated Hemoglobin, Body Weight and Blood Pressure in Type 2 Diabetes Patients Initiating Dapagliflozin Treatment in Primary Care: A Retrospective Study

John Wilding, Clifford Bailey, Una Rigney, Betina Blak, Wendy Beekman, Cathy Emmas, John Wilding, Clifford Bailey, Una Rigney, Betina Blak, Wendy Beekman, Cathy Emmas

Abstract

Introduction: The present study aimed to describe characteristics of patients with type 2 diabetes (T2D) in UK primary care initiated on dapagliflozin, post-dapagliflozin changes in glycated hemoglobin (HbA1c), body weight and blood pressure, and reasons for adding dapagliflozin to insulin.

Methods: Retrospective study of patients with T2D in the Clinical Practice Research Datalink with first prescription for dapagliflozin. Patients were included in the study if they: (1) had a first prescription for dapagliflozin between November 2012 and September 2014; (2) had a Read code for T2D; (3) were registered with a practice for at least 6 months before starting dapagliflozin; and (4) remained registered for at least 3 months after initiation. A questionnaire ascertained reason(s) for adding dapagliflozin to insulin.

Results: Dapagliflozin was most often used as triple therapy (27.7%), dual therapy with metformin (25.1%) or added to insulin (19.2%). Median therapy duration was 329 days [95% confidence interval (CI) 302-361]. Poor glycemic control was the reason for dapagliflozin initiation for 93.1% of insulin-treated patients. Avoiding increases in weight/body mass index and insulin resistance were the commonest reasons for selecting dapagliflozin versus intensifying insulin. HbA1c declined by mean of 9.7 mmol/mol (95% CI 8.5-10.9) (0.89%) 14-90 days after starting dapagliflozin, 10.2 mmol/mol (95% CI 8.9-11.5) (0.93%) after 91-180 days and 12.6 mmol/mol (95% CI 11.0-14.3) (1.16%) beyond 180 days. Weight declined by mean of 2.6 kg (95% CI 2.3-2.9) after 14-90 days, 4.3 kg (95% CI 3.8-4.7) after 91-180 days and 4.6 kg (95% CI 4.0-5.2) beyond 180 days. In patients with measurements between 14 and 90 days after starting dapagliflozin, systolic and diastolic blood pressure decreased by means of 4.5 (95% CI -5.8 to -3.2) and 2.0 (95% CI -2.9 to -1.2) mmHg, respectively from baseline. Similar reductions in systolic and diastolic blood pressure were observed after 91-180 days and when follow-up extended beyond 180 days. Results were consistent across subgroups.

Conclusion: HbA1c, body weight and blood pressure were reduced after initiation of dapagliflozin in patients with T2D in UK primary care and the changes were consistent with randomized clinical trials.

Funding: AstraZeneca.

Keywords: Blood pressure; Body weight; Dapagliflozin; Diabetes; Glycated hemoglobin; HbA1c.

Figures

Fig. 1
Fig. 1
Disposition of patients. Met metformin, SU sulphonylurea, DPP-4 dipeptiyl peptidase 4 inhibitor, TZD thiazolidlnedione, GLP-1 glucagon-like peptide 1 receptor agonist
Fig. 2
Fig. 2
Reasons for use of dapagliflozin with insulin other than more/maximal intensification
Fig. 3
Fig. 3
a Changes in glycated hemoglobin (mmol/mol) from baseline for each of the main treatment groups and the entire cohort for the three follow-up periods; error bars represent mean ± 95% confidence interval. b Changes in glycated hemoglobin (mmol/mol) from baseline by tertiles of baseline glycated hemoglobin for the three follow-up periods; error bars represent mean ± 95% confidence interval. c Changes in glycated hemoglobin (mmol/mol) from baseline by categories of baseline body mass index for the three follow-up periods; error bars represent mean ± 95% confidence interval
Fig. 3
Fig. 3
a Changes in glycated hemoglobin (mmol/mol) from baseline for each of the main treatment groups and the entire cohort for the three follow-up periods; error bars represent mean ± 95% confidence interval. b Changes in glycated hemoglobin (mmol/mol) from baseline by tertiles of baseline glycated hemoglobin for the three follow-up periods; error bars represent mean ± 95% confidence interval. c Changes in glycated hemoglobin (mmol/mol) from baseline by categories of baseline body mass index for the three follow-up periods; error bars represent mean ± 95% confidence interval
Fig. 4
Fig. 4
Changes in body weight (kg) from baseline for each of the main treatment groups and the entire cohort for the three follow-up periods; error bars represent mean ± 95% confidence interval
Fig. 5
Fig. 5
a Changes in blood pressure (mmHg) from baseline for each of the main treatment groups and the entire cohort for the three follow-up periods; error bars represent mean ± 95% confidence interval. b Changes in blood pressure stratified by baseline blood pressure; for the three follow-up periods; error bars represent mean ± 95% confidence interval

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