Dapagliflozin Superior to Sitagliptin in Lowering T2D Cardiovascular Risk Factors

In people with uncontrolled type 2 diabetes, dapagliflozin was superior to sitagliptin in reducing 3 major cardiovascular risk factors.

SAN FRANCISCO — In people with uncontrolled type 2 diabetes (T2D), dapagliflozin was superior to sitagliptin in reducing 3 major cardiovascular risk factors, according to research results presented at the American Diabetes Association 79th Scientific Sessions, held June 7 to 11, 2019, in San Francisco, California.

Sodium-glucose cotransporter 2 inhibitors have received attention because of their association with improved cardiovascular outcomes in people with T2D, whereas dipeptidyl peptidase-4 inhibitors are reportedly neutral on cardiovascular outcomes. Researchers conducted a prospective randomized parallel-group trial to compare the efficacy of dapagliflozin with that of sitagliptin in reducing cardiovascular disease risk in T2D, with attention given to 3 major risk factors: body weight, HbA1c, and hypoglycemia.

The study included 340 people with T2D receiving metformin monotherapy or no glucose-lowering agents. Participants were age 20 to 80 years with HbA1c ≥7.1% and <10.0%. They were randomly assigned 1:1 to 24 weeks of treatment with dapagliflozin 5 mg/d or sitagliptin 50 mg/d. If participants had HbA1c levels ≥7.0% after the initial 8 weeks, the dose of dapagliflozin was increased to 10 mg/d and sitagliptin was increased to 100 mg/d. The primary study end point was the ratio of achieving the composite of the following 3 items: HbA1c <7.0%, 3.0% body weight loss from baseline, and avoidance of hypoglycemia (<3.0 mmol/L). A flash glucose monitoring system was used to monitor hypoglycemia.

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Both cohorts achieved similar ratios of HbA1c <7.0% (49.4% for dapagliflozin vs 50.0% for sitagliptin; P =1.00) and there was no significant difference between groups for the avoidance of hypoglycemia (88.7% for dapagliflozin vs 92.3% for sitagliptin; P =.27). However, participants in the dapagliflozin group were more likely to achieve a 3.0% body weight loss (54.4% vs 19.6%; P <.001). Overall, the dapagliflozin group achieved superior ratios of the composite end points compared with the sitagliptin group (24.4% vs 13.8%; P <.05).

The study investigators suggested that these data provide evidence for the ideal therapeutic choice for preventing cardiovascular events in T2D.

Disclosures: Several authors disclosed associations with the pharmaceutical industry. Please see the original abstract for a full list of authors’ disclosures.

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Fuchigami A, Shigiyama F, Kitazawa T, et al. The study of dapagliflozin vs. sitagliptin treatment efficacy on prevention of cardiovascular risk factors in type 2 diabetes patients: the DIVERSITYCVR study. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco, CA. Poster 21-LB.