SGLT-2-remmers: glucosurie als diabetesbehandeling

Objective

To describe the efficacy and safety of dapagliflozin, the first sodium-glucose co-transporter-2 (SGLT-2) inhibitor for the treatment of diabetes mellitus type 2 (DM2) to be registered in the Netherlands.

Design

Literature review.

Method

We searched the Medline database for articles on the use of dapagliflozin in patients with DM2. We included randomised studies with a minimum duration of 12 weeks and systematic reviews published up to 19 October 2012. Two assessors selected the articles on the basis of title, abstract and if necessary, the complete text.

Results

Eleven articles were suitable for analysis. On comparison with placebo, the use of dapagliflozin gave a drop in HbA_1c-value of approximately 0.5-0.8 percentage points (6-9 mmol/mol). The body weight of patients who used dapagliflozin dropped between 1.0-2.4 kg on comparison with the placebo and metformin control groups. Urinary tract infections occurred twice as often and genital infections three to four times more often. There were no data on the effect on micro- and macrovascular complications or on mortality.

Conclusion

Dapagliflozin regulates the blood glucose levels less effectively than currently used medications, although the small number of studies that compare dapagliflozin with metformin or glipizide show no differences in the drop in HbA_1c between the study groups. Dapagliflozin use leads to minor, clinically non-relevant weight loss. There are as yet no data on its long term efficacy and safety.

Conflict of interest and financial support: a disclosure form provided by the author is available along with the full text of this article at www.ntvg.nl, search for A5969; click on ‘Belangenverstrengeling’ (‘Conflict of interest’).