Dapagliflozin and new-onset type 2 diabetes in patients with chronic kidney disease or heart failure: pooled analysis of the DAPA-CKD and DAPA-HF trials

Analysis (n=4,003) found treatment with dapagliflozin reduced the incidence of new onset type 2 diabetes (4.3% versus 6.3% in the placebo groups over a median follow-up of 21.2 months; HR 0.67; 95% CI 0.51 to 0.88; p=0.0040), although there was no change in mean HbA1c.

SPS commentary:

The UK license for dapagliflozin was recently extended to include its use in the treatment of chronic kidney disease. NICE has issued DRAFT guidance recommending it as an option for treating chronic kidney disease in adults, only if:

  • it is an add-on to optimised standard care including ACE inhibitors or angiotensin-receptor blockers , unless these are contraindicated or not tolerated, and
  • people have an eGFR of 25 ml/min/1.73 m2 to 75 ml/min/1.73 m2 and:

− a urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more or

− a uACR of 3 mg/mmol or more and type 2 diabetes.

 

A related Comment notes although it is intellectually stimulating to consider the why and how of the observed reduction in new onset type 2 diabetes in this pooled analysis, there are already sufficiently compelling reasons to use SGLT2 inhibition in patients with chronic kidney disease and heart failure to reduce the risk of both cardiovascular and renal outcomes.

The Lancet Diabetes & Endocrinology

Resource links:

DRAFT NICE guidance

Comment