Type 2 Diabetes is a long-term, progressive disease that requires long-term treatment. In the real world, SGLT2 inhibitors have become commonly used drugs that have demonstrated their ability to decrease blood glucose, blood pressure, and body weight in T2D patients, with a prognostic benefit to the kidneys. However, the comparative efficacy and safety of SGLT2 inhibitors among similar drugs at different doses are not known. Previously, dapagliflozin (DPG) was limited to patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m², whereas empagliflozin (EPG) could be used for those with an eGFR ≥45 mL/min/1.73 m². Therefore, many patients were switched from DPG to EPG when the eGFR decreased. This switch was confirmed to be relatively safe as the switch from DPG to EPG in T2D patients was efficient in maintaining blood glucose levels and caused no significant changes in renal function.

A single-center, retrospective study was conducted to compare the long-term effectiveness and safety of SGLT2 inhibitors (dapagliflozin versus empagliflozin) as an add-on therapy to hypoglycemic agents in T2D patients. The epidemiological study also evaluated the safety of the drugs by documenting adverse drug reactions for all the participants. The primary outcome was set as the difference between hemoglobin A1c (HbA1c) values observed at baseline and the value after 36 months of treatment, including the proportion of participants with HbA1c levels in the range of <7.0% and <6.5%.

Out of 680 patients, 234 patients were selected based on the propensity score from both the dapagliflozin and empagliflozin groups. After 36 months of treatment, clinical parameters (including HbA1c, fasting plasma glucose, alanine aminotransferase, triglyceride levels, body weight, and systolic blood pressure) decreased significantly in both groups. The changes from the baseline for the physiological values and clinical parameters did not vary among the different dose groups of SGLT2 inhibitors. However, between both the DPG and EPG groups, nearly half of the baseline HbA1c values were 7–7.9% before treatment. After 36 months of treatment, the proportion with HbA1c<7% was significantly higher in the DPG group than in the EPG group. The incidence of adverse drug reactions was documented in 134 (7.2%) patients using DPG and 95 (7.7%) patients using EPG during the study period. It was also seen that the majority of patients experienced symptoms during the first 3 months of treatment, with only 18 patients in the DPG group and 10 patients in the EPG group experiencing adverse reactions after 3 months. Hence, it can be concluded that the long-term continuous use of either dapagliflozin or empagliflozin as add-on therapy to hypoglycemic drugs for T2D patients is synergistically effective for lowering blood glucose, reducing body weight, and stabilizing blood pressure. Additionally, there was no significant difference in efficacy between dapagliflozin and empagliflozin, even with the administration of different doses of these agents.

Reference: Yang Aa and Chen HC, J Diabetes Res. 2022 May 23;2022:2420857.

Doi: 10.1155/2022/2420857.