A Retrospective Real-World Study of Dapagliflozin Versus Other Oral Antidiabetic Drugs Added to Metformin in Patients with Type 2 Diabetes

Objectives: The efficacy of dapagliflozin as add-on therapy to metformin has been assessed in randomized trials. However, its effectiveness has not been assessed in a US real-world setting. Methods: Electronic medical record (EMR) data were used to compare clinical outcomes among patients with type 2 diabetes (T2D) treated with dapagliflozin and metformin with or without other oral antidiabetic drugs (D + M +/- OAD), versus metformin with at least 1 other OAD (M + OAD). Adult patients with T2D on these regimens from January 01, 2014, to February 28, 2015, were identified in a US EMR database, with the date of first prescription for dapagliflozin (D + M +/- OAD) or other OAD (M + OAD) as the index date. Patients were observed for 12 months before the index date (baseline) and 12 months afterward (ie, follow-up). Patients in the M + OAD group were propensity score matched 1: 1 to those in the D + M +/- OAD group. Outcomes included change in glycated hemoglobin (A1C) level, weight, and systolic and diastolic blood pressures (SBP/DBP) from baseline to follow-up. Results: A total of 1093 patients receiving M + OAD were matched to 1093 patients receiving D + M +/- OAD. Compared with those given M + OAD, patients given D + M +/- OAD had a greater reduction in A1C level (mean, -1.0% vs -0.7%; P <. 01), greater weight loss (-1.8 kg vs -0.7 kg, P <. 01), and greater change in SBP (-3.6 mm Hg vs -0.1 mm Hg, P <. 01) and DBP (-2.0 mm Hg vs -0.6 mm Hg, P <. 01) from baseline to follow-up. Conclusions: In current US clinical practice, patients receiving D + M +/- OAD had greater reductions in important clinical outcomes of T2D-A1C level, weight loss, and blood pressure-versus patients receiving M + OAD. This study supports the use of dapagliflozin as add-on therapy to metformin with or without other OADs for patients with T2D.