title: Glycated Hemoglobin, Body Weight and Blood Pressure in Type 2 Diabetes Patients Initiating Dapagliflozin Treatment in Primary Care: A Retrospective Study.
abstract: BACKGROUND
  The present study aimed to describe characteristics of patients with type 2 diabetes (T2D) in UK primary care initiated on dapagliflozin, post-dapagliflozin changes in glycated hemoglobin (HbA1c), body weight and blood pressure, and reasons for adding dapagliflozin to insulin.
  
  
  METHODS
  Retrospective study of patients with T2D in the Clinical Practice Research Datalink with first prescription for dapagliflozin. Patients were included in the study if they: (1) had a first prescription for dapagliflozin between November 2012 and September 2014; (2) had a Read code for T2D; (3) were registered with a practice for at least 6 months before starting dapagliflozin; and (4) remained registered for at least 3 months after initiation. A questionnaire ascertained reason(s) for adding dapagliflozin to insulin.
  
  
  RESULTS
  Dapagliflozin was most often used as triple therapy (27.7%), dual therapy with metformin (25.1%) or added to insulin (19.2%). Median therapy duration was 329 days [95% confidence interval (CI) 302-361]. Poor glycemic control was the reason for dapagliflozin initiation for 93.1% of insulin-treated patients. Avoiding increases in weight/body mass index and insulin resistance were the commonest reasons for selecting dapagliflozin versus intensifying insulin. HbA1cdeclined by mean of 9.7 mmol/mol (95% CI 8.5-10.9) (0.89%) 14-90 days after starting dapagliflozin, 10.2 mmol/mol (95% CI 8.9-11.5) (0.93%) after 91-180 days and 12.6 mmol/mol (95% CI 11.0-14.3) (1.16%) beyond 180 days. Weight declined by mean of 2.6 kg (95% CI 2.3-2.9) after 14-90 days, 4.3 kg (95% CI 3.8-4.7) after 91-180 days and 4.6 kg (95% CI 4.0-5.2) beyond 180 days. In patients with measurements between 14 and 90 days after starting dapagliflozin, systolic and diastolic blood pressure decreased by means of 4.5 (95% CI -5.8 to -3.2) and 2.0 (95% CI -2.9 to -1.2) mmHg, respectively from baseline. Similar reductions in systolic and diastolic blood pressure were observed after 91-180 days and when follow-up extended beyond 180 days. Results were consistent across subgroups.
  
  
  CONCLUSIONS
  HbA1c, body weight and blood pressure were reduced after initiation of dapagliflozin in patients with T2D in UK primary care and the changes were consistent with randomized clinical trials.
  
  
  BACKGROUND
  AstraZeneca.
authors: Diabetes and Endocrinology Research Group, Institute of Ageing and Chronic Disease, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK. j.p.h.wilding@liv.ac.uk.
authors: John
authors: J
authors: Wilding
authors: Life and Health Sciences, Aston University, Birmingham, UK.
authors: Clifford
authors: C
authors: Bailey
authors: AstraZeneca, 600 Capability Green, Luton, UK.
authors: Una
authors: U
authors: Rigney
authors: AstraZeneca, 600 Capability Green, Luton, UK.
authors: Betina
authors: B
authors: Blak
authors: AstraZeneca, Louis Pasteurlaan 5, 2719 EE, Zoetermeer, The Netherlands.
authors: Wendy
authors: W
authors: Beekman
authors: AstraZeneca, 600 Capability Green, Luton, UK.
authors: Cathy
authors: C
authors: Emmas
keywords: Blood pressure; Body weight; Dapagliflozin; Diabetes; Glycated hemoglobin; HbA1c