Effect of Dapagliflozin on Glycemic Control, Weight, and Blood Pressure in Patients with Type 2 Diabetes Attending a Specialist Endocrinology Practice in Canada: A Retrospective Cohort Analysis

Background: In randomized clinical trials, dapagliflozin has been shown to improve glycemic control, weight, and blood pressure. However, there is little real-world evidence of the effectiveness of dapagliflozin. The objective of this study is to investigate the real-world treatment outcomes of patients with type 2 diabetes (T2D) who initiated dapagliflozin in a referral-based endocrinology practice. Methods: This study was a retrospective cohort analysis of patients with T2D who initiated dapagliflozin in 2015, using data from a large, specialist diabetes registry in Canada. Results: 1520 patients were eligible for analysis. Following 3 to 6 months of treatment, hemoglobin A1c (HbA1c) decreased by a mean of 0.9%1.3% (9.8 +/- 14.2mmol/mol) (P<0.01), weight decreased 2.2 +/- 3.1kg (P<0.01), and systolic blood pressure decreased 3.7 +/- 14.3mmHg (P<0.01). The proportion of patients who achieved glycemic control (HbA1c 7.0%) increased from 7.0% at baseline to 27.0% during follow-up. There was also a statistically significant decrease from baseline in body mass index, diastolic blood pressure, fasting glucose, total cholesterol, low-density lipoprotein cholesterol, triglycerides, alanine aminotransferase, and the proportion of patients with microalbuminuria (P<0.01). A higher baseline HbA1c, shorter duration of diabetes, male gender, and greater weight loss were each independently associated with a greater reduction in HbA1c (P<0.01). Conclusions: In a real-world clinical setting in Canada, dapagliflozin produced significant improvements in HbA1c, weight, and blood pressure in patients with T2D, comparable to that seen in randomized clinical trials.