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Multicenter Study
. 2023 Jul;46(7):1429-1439.
doi: 10.1007/s40618-022-02002-2. Epub 2023 Jan 9.

Short-term effectiveness of dapagliflozin versus DPP-4 inhibitors in elderly patients with type 2 diabetes: a multicentre retrospective study

M L Morieri  1 , I Raz  2 , A Consoli  3 , M Rigato  1   4 , A Lapolla  1 , F Broglio  5 , E Bonora  6 , A Avogaro  1 , G P Fadini  7 ; DARWIN-FUP network
Collaborators, Affiliations
Multicenter Study

Short-term effectiveness of dapagliflozin versus DPP-4 inhibitors in elderly patients with type 2 diabetes: a multicentre retrospective study

M L Morieri et al. J Endocrinol Invest. 2023 Jul.

Abstract

Aim: To compare effectiveness of dapagliflozin versus DPP-4 inhibitors on individualized HbA1c targets and extra-glycaemic endpoints among elderly patients with type 2 diabetes (T2D).

Methods: This was a multicentre retrospective study on patients aged 70-80 years with HbA1c above individualized target and starting dapagliflozin or DPP-4 inhibitors in 2015-2017. The primary outcome was the proportion reaching individualized HbA1c targets. Confounding by indication was addressed by inverse probability of treatment weighting (IPTW), multivariable adjustment (MVA), or propensity score matching (PSM).

Results: Patients initiating dapagliflozin (n = 445) differed from those initiating DPP-4i (n = 977) and balance between groups was achieved with IPTW or PSM. The median follow-up was 7.5 months and baseline HbA1c was 8.3%. A smaller proportion of patients initiating dapagliflozin attained individualized HbA1c target as compared to those initiating DPP-4 inhibitors (RR 0.73, p < 0.0001). IPTW, MVA, and PSM yielded similar results. Between-group difference in the primary outcome was observed among patients with lower eGFR or longer disease duration. Dapagliflozin allowed greater reductions in body weight and blood pressure than DPP-4 inhibitors.

Conclusions: Elderly patients with T2D initiating dapagliflozin had a lower probability of achieving individualized HbA1c targets than those initiating DPP-4 inhibitors but displayed better improvements in extra-glycaemic endpoints.

Keywords: Aging; Cardiovascular; Heart failure; Kidney disease; Observational.

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Conflict of interest statement

MLM received lecture fees or advisory board fees from Eli Lilly, MSD, Novo Nordisk, SLAPharma, and Servier. IR Advisory Board: AstraZeneca, Eli Lilly and Company, Novo Nordisk Consultant: AstraZeneca, Curolife, BOL Pharma Speaker’s Bureau: AstraZeneca, Eli Lilly and Company, Novo Nordisk. AC has consulting relationships with Astra Zeneca and Novo Nordisk; has participated in advisory panels for Abbot, Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Novo-Nordisk, Sanofi-Aventis, Takeda; has received speaker fees from Abbot, Astra Zeneca, Boehringer Ingelheim, Bruno Farmaceutici, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Novo-Nordisk, Sanofi-Aventis, Takeda; has received research supporting grants from Astra Zeneca, Eli Lilly, Novo Nordisk. MR received lecture and advisory board fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Mundipharma, and Novo Nordisk. AL received grant support, lecture or advisory board fees from Novo Nordisk, Sanofi, Abbott, and Eli Lilly. FB was a consultant for Boehringer Ingelheim–Eli Lilly and Company and received lecture fees from Boehringer Ingelheim–Eli Lilly and Company and AstraZeneca. EB received honoraria from Eli Lilly and Company, Novo Nordisk, and Sanofi; travel support from Eli Lilly and Company and Servier Laboratories; and has participated on advisory boards for Abbott, AstraZeneca, Bayer, Becton Dickinson, Boehringer Ingelheim, Daiichi-Sanyo, Eli Lilly and Company, MSD, Novo Nordisk, and Sanofi. AA received research grants, lecture, or advisory board fees from Merck Sharp & Dome, AstraZeneca, Novartis, Boeringher-Ingelheim, Sanofi, Mediolanum, Janssen, Novo Nordisk, Lilly, Servier, and Takeda. GPF received lecture or consultancy fees or grant support from Abbott, AstraZeneca, Boehringer, Lilly, Merck-Sharp-Dome, Mundipharma, Novartis, Novo Nordisk, Sanofi, and Servier.

Figures

Fig. 1
Fig. 1
Primary analysis. Probability of reaching the individualized target in initiators of dapagliflozin versus initiators of DPP-4i. a Analysis with inverse probability of treatment weighting (IPTW). b Analysis with multivariable adjustment (MVA). c Analyses with propensity score matching (PSM). The relative risk (RR) is shown with 95% confidence interval (CI) in the intention-to-treat and in the as-treated datasets separately
Fig. 2
Fig. 2
Subgroup analyses. The primary analysis was performed after stratification based on diabetes duration and eGFR quartiles. Results are shown as relative risk (RR) for dapagliflozin versus DPP-4i with 95 confidence interval (CI)
See this image and copyright information in PMC

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