POEMs

Patient-Oriented Evidence That Matters

Dapagliflozin in High-Risk Type 2 Diabetes Reduces Hospitalization for Heart Failure But Does Not Reduce Death, Myocardial Infarction, or Stroke

 

Am Fam Physician. 2019 Aug 1;100(3):184-185.

Clinical Question

Does dapagliflozin (Farxiga) improve cardiovascular outcomes in patients with type 2 diabetes mellitus and cardiovascular disease?

Bottom Line

The only cardiovascular benefit to treatment with dapagliflozin was a reduction in the likelihood of hospitalization; 125 patients would need to be treated for 10 years to prevent one hospitalization. For patients with type 2 diabetes and heart failure, that might tip the scales in favor of dapagliflozin (or another sodium glucose co-transporter 2 [SGLT2] inhibitor) as a second or third drug choice. The researchers promote a reduction in the composite of cardiovascular death or hospitalization for heart failure, but there is no reduction in cardiovascular death. This composite is good marketing, but bad science. (Level of Evidence = 1b)

Synopsis

Dapagliflozin is one of several SGLT2 inhibitors that induce glucosuria to lower blood glucose levels. In the current study, researchers identified patients 40 years or older with type 2 diabetes and established cardiovascular disease or men who were 55 years or older (60 or older for women) with one or more cardiovascular risk factors in addition to age. Patients had to have an A1C level between 6.5% and 12% and creatinine clearance of at least 60 mL per minute per 1.73 m2 (1 mL per second per m2). After a four- to eight-week placebo run-in period, approximately 25% of the patients who were initially enrolled were excluded, largely because they did not meet the laboratory criteria (although the stated purpose of the run-in period in the study protocol document was to identify nonadherent patients). Patients could receive other medications to treat their diabetes at the discretion of their physician.

A total of 17,160 patients were randomized to receive dapagliflozin, 10 mg, or placebo. Groups were balanced, with a mean age of 64 years, a mean body mass index of 32 kg per m2, with 41% of patients having cardiovascular disease, and 59% having multiple risk factors. They were co


Editor's Note: Dr. Ebell is Deputy Editor for Evidence-Based Medicine for AFP and cofounder and Editor-in-Chief of Essential Evidence Plus.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

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