Comparing Effects of SGLT2 Inhibitors on HbA1c and Weight
This updated analysis from the Association of British Clinical Diabetologists (ABCD) audit programmes compares the effects of different sodium-glucose link transporter 2 inhibitors (SGLT2i) on HbA1c and weight in the real world. The study includes data on Empagliflozin, Dapagliflozin, and Canagliflozin, with findings suggesting efficacy in reducing HbA1c and weight, but difficulty in characterizing differences between the inhibitors. Methods involved data extraction from ABCD audit tools and analysis using Stata 16. Baseline characteristics of patients taking SGLT2 inhibitors are also provided.
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A20 Thursday 22nd April 17.00 Comparing the effects of different sodium-glucose link transporter 2 inhibitors (SGLT2i) on HbA1c and weight in the real world: updated analysis from the Association of British Clinical Diabetologists (ABCD) audit programmes TSJ Crabtree1-3; K Dhatariya4; A Bickerton5; S Sivappriyan6; S Tarpey7; S Rowles7; K Adamson8; I Gallen9; REJ Ryder1; on behalf of ABCD SGLT2i audit contributors 1. Sandwell and West Birmingham Hospitals NHS Trust; 2. University Hospitals of Derby and Burton NHS Trust; 3. University of Nottingham; 4. Norfolk & Norwich University Hospitals NHS Trust; 5. Yeovil District Hospital NHS Foundation Trust; 6. Maidstone and Tunbridge Wells Hospitals NHS Trust; 7. Pennine Acute Hospitals NHS Trust; St John s Hospital, Livingston; 9. Royal Berkshire Hospitals NHS Trust
Disclosures TSJC has received an educational grants and speaker fees from Novo Nordisk and Sanofi
The ABCD audit programmes First audit launuched in 2014 (Dapagliflozin) Subsequent Canagliflozin (2016) and Empagliflozin (2017) audits Aims: To collect anonymised routine clinical data for patients taking SGLT2s in order to provide real-world data on it s use Data input: Primary care via the online audit tool Primary care via data submitted by clinical commissioning groups Secondary care via the online audit tool
What we know so far SGLT2s are efficacious in reducing Hba1c and weight in clinical trials Differences across the class difficult to characterise Paucity of evidence to suggest one is better than the others
Methods Data were extracted from the ABCD audit tools Those with baseline data and relevant follow-up data were included in the analysis for first return (within 3-9 months from commencement) Total of 15,044 patients included: Empagliflozin 7,404 Dapagliflozin 5,793 Canagliflozin 1,847 Analysis conducted in Stata 16 using paired t-test and ANOVA with Bonferroni corrections for pairwise comparisons
Baseline characteristics Empagliflozin 7,404 60.0 10.5 60.9% 98.1 21.4 34.0 6.7 8.3 (4.2-12.8) 9.2 1.6 77.5 17.2 80.8 11.8 Canagliflozin 1,847 60.6 10.7 61.5% 97.6 21.9 33.7 6.8 8.4 (4.1-12.7) 9.1 1.6 76.3 17.2 78.5 13.0 Dapagliflozin 5,793 60.2 10.3 59.7% 98.8 21.8 34.3 6.8 7.9 (4.1-12) 9.1 1.6 76.0 17.1 80.8 12.1 Total 15,044 60.1 10.4 60.5% 98.3 21.6 34.1 6.7 8.1 (4.1-12.4) 9.2 1.6 76.8 17.2 80.5 12.1 n= Age, mean SD Gender, % male Weight (kg), mean SD BMI (kg/m2), mean SD Diabetes duration (years), median (IQR) HbA1c (%), mean SD HbA1c (mmol/mol), mean SD eGFR (mL/min/1.73m2), mean SD
Figures 1 Empagliflozin (n=5,164) Canagliflozin (n=1,283) Dapagliflozin (n=4,102) 10,459/15,044 with available weight data Significant reductions in weight associated with all 3 SGLT2i (P<0.0001) Empagliflozin significantly better than Dapa- (P<0.01) but not Cana- (P=0.07) No statistical difference between Cana- and Dapa- Total (n=10,459) 0 -0.5 -1 Change in weight, kg -1.5 -2 -2.5 -3 -3.5 -4 All results in figures significant to P<0.05. Error bars showing 95% CI
Figures 2 14,359/15,044 with available HbA1c data Significant reductions in HbA1c associated with SGLT2i commencement across the class (P<0.0001) Changes with Empagliflozin larger than both Dapa- (P<0.0001) and Cana- (P<0.05) No statistical difference between Dapa- and Cana- (P=1.00) Empagliflozin (n=7,115) Canagliflozin (n=1,737) Dapagliflozin (n=5,507) Total (n=14,359) 0 -2 Change in HbA1cm, mmol/mol -4 -6 -8 -10 -12 -14 All results in figures significant to P<0.05. Error bars showing 95% CI
Discussion Empagliflozin appears to be associated with a superior HbA1c and weight response to treatment than Dapagliflozin and Canagliflozin This could be due to genuine superiority of this SGLT2i over others However there may be possible confounding factors Different population Larger number of users Length of follow-up
Further work Continue to collect data for inclusion in the audit programmes Establish real-world associations: Across multiple parameters (paper in progress) Across multiple time-points In differing drug combinations
Thanks for listening Want to learn more about the ABCD audit programmes: ABCD.care/ABCD-nationwide-audits Current audits: Semaglutide DIY APS SGLT2 Testosterone
