NICE guidance - dapagliflozin in combination therapy for treating type 2 diabetes

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  • Dapagliflozin in a dual therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if:
    • a sulfonylurea is contraindicated or not tolerated
    • or the person is at significant risk of hypoglycaemia or its consequences

  • Dapagliflozin in combination with insulin with or without other antidiabetic drugs is recommended as an option for treating type 2 diabetes

  • Dapagliflozin in a triple therapy regimen is recommended as an option for treating type 2 diabetes in adults, only in combination with metformin and a sulfonylurea.

For details then consult full guidance (1,2).

Notes:

  • dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that blocks the reabsorption of glucose in the kidneys and promotes excretion of excess glucose in the urine. It has a UK marketing authorisation ’in adults aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control as:
      • monotherapy when diet and exercise alone do not provide adequate glycaemic control in patients for whom use of metformin is considered inappropriate due to intolerance
      • add-on combination therapy with other glucose-lowering agents including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control’
    • summary of product characteristics lists the following adverse reactions for dapagliflozin: hypoglycaemia (when used with a sulfonylurea or insulin), urinary tract and genital infection, back pain, dysuria, polyuria, dyslipidaemia and elevated haematocrit.
      • not recommended for use in people with moderate to severe renal impairment (patients with a creatinine clearance rate of less than 60 ml/min or an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2) because its efficacy is dependent on renal function
      • not recommended for use in combination with pioglitazone. For full details of adverse reactions and contraindications, see the summary of product characteristics

Reference:

Last reviewed 07/2018

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