Jun Ji Eun, Kim Kyoung-Ah, Kim Nan-Hee, Lee Kwan-Woo, Jeong In-Kyung
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea.
Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
Endocrinol Metab (Seoul). 2025 Apr;40(2):278-288. doi: 10.3803/EnM.2024.2142. Epub 2025 Mar 19.
Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduces hyperglycemia and obesity by inhibiting renal glucose reabsorption. This post hoc study evaluated clinical factors influencing patient response to dapagliflozin.
The analysis focused on patients treated with dapagliflozin (10 mg/day for 52 weeks) within the randomized, double-blind, parallel-group BEYOND trial. Adequate glycemic control (GC) was defined as a reduction in glycated hemoglobin (HbA1c) of ≥ 1.0% or the achievement of an HbA1c level <7.0% at week 52. Significant weight loss (WL) referred to a reduction in body weight of ≥3.0% at week 52. Participants were classified into four groups based on their GC and WL responses: GC+/WL+, GC+/WL-, GC-/WL+, and GC-/WL-.
Among dapagliflozin recipients (n=56), at 52 weeks, HbA1c had decreased by 1.0%±0.8% from baseline, while body weight had declined by 2.4±3.1 kg. Overall, 69.6% of participants achieved GC+, and 57.1% achieved WL+. Male sex and shorter diabetes duration were significantly associated with achieving GC+. Conversely, higher estimated glomerular filtration rate was significantly linked to WL+. The only factor significantly associated with both GC+ and WL+ was shorter diabetes duration (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97; P=0.023). The GC+ and WL+ groups exhibited favorable responses beginning soon after dapagliflozin therapy was initiated. Furthermore, HbA1c decline was more strongly associated with reduction in visceral fat than with WL.
A short duration of diabetes and early response to treatment appear to represent key factors in maximizing the benefits of dapagliflozin for blood glucose and weight management.
达格列净是一种钠-葡萄糖协同转运蛋白2抑制剂，通过抑制肾脏对葡萄糖的重吸收来降低高血糖和肥胖。这项事后分析研究评估了影响患者对达格列净反应的临床因素。
该分析聚焦于在随机、双盲、平行组BEYOND试验中接受达格列净治疗（10毫克/天，持续52周）的患者。血糖控制良好（GC）定义为糖化血红蛋白（HbA1c）降低≥1.0%，或在第52周时HbA1c水平<7.0%。显著体重减轻（WL）指在第52周时体重减轻≥3.0%。参与者根据其GC和WL反应分为四组：GC+/WL+、GC+/WL-、GC-/WL+和GC-/WL-。
在接受达格列净治疗的患者（n = 56）中，第52周时，HbA1c较基线水平下降了1.0%±0.8%，而体重下降了2.4±3.1千克。总体而言，69.6%的参与者实现了GC+，57.1%的参与者实现了WL+。男性和较短的糖尿病病程与实现GC+显著相关。相反，较高的估计肾小球滤过率与WL+显著相关。与GC+和WL+均显著相关的唯一因素是较短的糖尿病病程（比值比，0.81；95%置信区间，0.68至0.97；P = 0.023）。GC+和WL+组在开始达格列净治疗后不久就表现出良好的反应。此外，HbA1c的下降与内脏脂肪减少的相关性比与体重减轻的相关性更强。
糖尿病病程短和对治疗的早期反应似乎是使达格列净在血糖和体重管理方面获益最大化的关键因素。
