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Dapagliflozin Versus Glipizide as Add-On Therapy in Patients With Type 2 Diabetes Who Have Inadequate Glycemic Control With Metformin: A Randomized, 52-week, Double-Blind, Active-Controlled Noninferiority Trial

Dapagliflozin Versus Glipizide as Add-On Therapy in Patients With Type 2 Diabetes Who Have Inadequate Glycemic Control With Metformin: A Randomized, 52-week, Double-Blind, Active-Controlled Noninferiority Trial

Michael A Nauck, Stefano Del Prato, Juris J Meier, Santiago Durán-García, Katja Rohwedder, Martina Elze, Shamik J Parikh

Diabetes Care. 2011 Sep;34(9):2015-22.

PMID: 21816980

Abstract:

Objective:
Although initially effective, sulfonylureas are associated with poor glycemic durability, weight gain, and hypoglycemia. Dapagliflozin, a selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), reduces hyperglycemia by increasing urinary glucose excretion independent of insulin and may cause fewer of these adverse effects. We compared the efficacy, safety, and tolerability of dapagliflozin with the sulfonylurea glipizide in patients with type 2 diabetes inadequately controlled with metformin monotherapy.
Research design and methods:
This 52-week, double-blind, multicenter, active-controlled, noninferiority trial randomized patients with type 2 diabetes (baseline mean HbA(1c), 7.7%), who were receiving metformin monotherapy, to add-on dapagliflozin (n = 406) or glipizide (n = 408) up-titrated over 18 weeks, based on glycemic response and tolerability, to ≤10 or ≤20 mg/day, respectively.
Results:
The primary end point, adjusted mean HbA(1c) reduction with dapagliflozin (-0.52%) compared with glipizide (-0.52%), was statistically noninferior at 52 weeks. Key secondary end points: dapagliflozin produced significant adjusted mean weight loss (-3.2 kg) versus weight gain (1.2 kg; P < 0.0001) with glipizide, significantly increased the proportion of patients achieving ≥5% body weight reduction (33.3%) versus glipizide (2.5%; P < 0.0001), and significantly decreased the proportion experiencing hypoglycemia (3.5%) versus glipizide (40.8%; P < 0.0001). Events suggestive of genital infections and lower urinary tract infections were reported more frequently with dapagliflozin compared with glipizide but responded to standard treatment and rarely led to study discontinuation.
Conclusions:
Despite similar 52-week glycemic efficacy, dapagliflozin reduced weight and produced less hypoglycemia than glipizide in type 2 diabetes inadequately controlled with metformin. Long-term studies are required to further evaluate genital and urinary tract infections with SGLT2 inhibitors.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP29094619-A	Glipizide		29094-61-9	Price

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