Dapagliflozin treatment for type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

CONTEXT: Type 2 diabetes has reached epidemic proportions and places a heavy burden on society. Dapagliflozin is a novel treatment choice for type 2 diabetes. OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of dapagliflozin treatment. DATA SOURCES: Medline (via PubMed), Embase (via OVID) and the Cochrane Library (up to August 2012) were searched, and RCTs were collected. STUDY SELECTION: Studies included type 2 diabetic subjects, who had been treated with dapagliflozin, and recorded HbA1c as outcomes. DATA EXTRACTION: Two reviewers independently assessed articles and study quality. Patient characteristics, interventions and outcomes were collected. DATA SYNTHESIS: Ten RCTs were included. Risk of bias for outcomes was low. Fixed or random effects models were used to pool the results. Dapagliflozin treatment was associated with a reduction in HbA1c [weighted mean difference (WMD): -0.53%; 95% confidence interval (CI): -0.58% to -0.47%; p < 0.00001], fasting plasma glucose (WMD: -1.06 mmol/L; 95% CI: -1.20, -0.92; p < 0.00001), and body weight (WMD: -1.63 kg; 95% CI: -1.83, -1.43; p < 0.00001). Dapagliflozin monotherapy did not lead to hypoglycaemia [relative risk (RR): 1.44; 95% CI: 0. 86, 2.41; p = 0.17], although hypoglycaemic risk increased (RR: 1.16; 95% CI: 1.05, 1.29; p = 0.005) when dapagliflozin was combined with other hypoglycaemic drugs. Dapagliflozin increased urinary glucose excretion (WMD: 26.98; 95% CI: 21.72, 32.24; p < 0.00001) and was associated with an increased risk of urinary tract infections (RR: 1.33; 95% CI: 1.10, 1.60; p = 0.004) and genital tract infections (RR: 3.23; 95% CI: 2.50, 4.18; p = 0.00001). CONCLUSIONS: Dapagliflozin appears to be an effective treatment for type 2 diabetes, although it may increase the risk of urinary tract infections and genital tract infections.