Drug treatment has traditionally been the mainstay of management for a wide range of diseases, from the mildest headache to the most metastasized cancer. Diabetes management is no different. Apart from lifestyle modification, it involves medications like insulin, metformin, dapagliflozin (Forxiga), jardiance, and a host of others. Medications like dapagliflozin that inhibit the sodium-glucose cotransporter 2 (SGLT2) can lower blood sugar in people with type 2 diabetes and also decrease the risk of serious complications. As a result of various studies carried out, scientists also recommend the use of SGLT-2 inhibitors for individuals with chronic kidney disease (CKD) because it promotes kidney survival.
Forxiga (Dapagliflozin ) Credit: Bristol Myers Squibb
Dapagliflozin prevents heart changes
Table of Contents
When a group of scientists did the CREDENCE trial they found that canagliflozin can reduce the risk of having renal complications in diabetics. Also, the DAPA-CKD trial showed that dapagliflozin preserves the kidneys in people with chronic kidney disease. So, yes we know dapagliflozin improves kidney function in those with diabetes and also in those with heart failure. However, no one has gotten evidence that this kidney-sparing effect works in people with both diabetes and heart failure.
Yoshihara and his colleagues set out to test the effects of dapagliflozin on kidney function in people with type 2 diabetes and heart failure. The trial was named DAPPER. They wanted to discover whether two years of treatment with the drug would reduce the level of urine albumin, a protein mostly found in the blood.
They recruited 294 patients between 20 and 85 years old and grouped them into two groups: people to be given dapagliflozin and people to be given other anti-diabetic drugs apart from SGLT2 inhibitors. The participants received 5mg of dapagliflozin and 10 mg as the need arose.
After two years, they observed no change in the albumin-creatinine ratio. Kidney function did not significantly improve, however, there were noticeable improvements in cardiac activity. Dapagliflozin seemed to limit the rate at which the walls of the heart change shape.
Clinical significance
The DAPPER trial has opened up more possibilities in the management of diabetes. The inclusion of SGLT-2 inhibitors in the anti-diabetic regimen of patients could decrease the occurrence of adverse cardiac complications. Its ability to reduce heart changes could lower the risk of hospitalization and death from heart failure. Also, adding it to the heart failure regimen of non-diabetic patients has proven to be beneficial.
Preventing complications
Dapagliflozin has proven to be very efficient in fighting CKD, so some trials say. In as much as the DAPPER research did not record any improvement in kidney function in patients with diabetes and heart failure, its effects on the heart and blood vessels have proven that it can be relied on.
Conclusion
While dapagliflozin has not proven very useful to the kidneys in patients who have both heart failure and diabetes, it is still beneficial to the kidneys in patients with only one of the comorbidities. Add in its effects on cardiac remodeling and it puts itself into contention as a must-have drug in any diabetic patient’s regimen, especially for those with at least one comorbidity.
References
Yoshihara, F., Imazu, M., Sakuma, I., Hiroi, Y., Hara, H., Okazaki, O., et al. (2023). DAPagliflozin for the attenuation of albuminuria in Patients with hEaRt failure and type 2 diabetes (DAPPER study): A multicentre, randomised, open-label, parallel-group, standard treatment-controlled trial. eClinicalMedicine. https://doi.org/10.1016/j.eclinm.2023.102334
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