Dapagliflozin is a highly selective renal sodium-glucose
co-transporter 2 (SGLT2) inhibitor [6] that lowers blood glucose in a dose-dependent, insulin-independent manner [7].
SGLT2 inhibitors act by reducing renal glucose reabsorption
from the proximal tubule, promoting excretion of excess glucose, net calorie loss, and improved glycaemic control [6,8,9].
Dapagliflozin was approved in the European Union in 2012 [10]
and in the USA in 2014 [11]. To evaluate the long-term efficacy
and tolerability of dapagliflozin, planned extensions to the original 52-week study included evaluations to 104 weeks (2 years)
and now to 208weeks (4years). At 2years, dapagliflozin was
found to have sustained glycaemic efficacy and to result in a
mean body weight reduction and 10-fold fewer hypoglycaemic
events compared with glipizide [12]. Dapagliflozin may therefore be a valuable alternative to existing add-on therapies, as it
improves glycaemic control with few adverse effects. The 4-year
efficacy and tolerability findings of the study are now described.
The present study is the longest clinical study of an SGLT2
inhibitor versus a commonly prescribed SU as add-on to metformin for the treatment of type 2 diabetes to date.