Blood glucose levels and bodyweight change after dapagliflozin administration

Aims/Introduction: Increased blood glucose or increased weight is often observed in patients who are prescribed sodium–glucose cotransporter 2 inhibitors (SGLT2i). The aim of this study was to determine in advance which patients, among those prescribed a SGLT2i, would be likely to have improved or worsened blood glucose levels and gain or loss of weight through the use of real-world data-based prescriptions. Materials and Methods: After 3 months of dapagliflozin prescription, patients were divided into four groups: H(+)W(+) for improved glucose and weight loss; H(+)W(−) for improved blood glucose and weight gain; H(−)W(+) for worsened glucose and weight loss; and H(−)W(−) for worsened glucose and weight gain. Results: The proportion of patients in the H(+)W(+) group was 53.5% (325/608 patients), H(+)W(−) was 19.7% (120/608), H(−)W(+) was 26.8% (114/608) and H(−)W(−) was 8.1% (49/608). The odds of proceeding to H(+)W(−) compared with H(+)W(+), which served as the reference, were 144% in baseline hemoglobin A1c (HbA1c) 7.0–8.0%, 233% in baseline HbA1c 8.0–9.0% and 359% in baseline HbA1c ≥ 9.0% (odds ratio 3.59, P < 0.05) compared with the reference. The odds of proceeding to H(−)W(+) were 29, 13 and 8%, respectively (all P < 0.05), and to H(−)W(−) were 17, 15 and 8%, respectively (all P < 0.05), compared with the reference. The results were expected to vary individually, because changes in blood glucose and bodyweight are more affected by diet and exercise than by drugs. Conclusions: When first prescribing dapagliflozin, a physician should be aware of the weight gain rather than glucose change if the baseline HbA1c is high, and might concentrate on weight-related lifestyle training, such as diet and exercise.