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Published on: December 1, 2023
Dapagliflozin as an Adjunct to Insulin Improves Time-in-Range and Glycemic Variability versus Acarbose in Adults With
Yixi Wu1, Yanting Chen2, Xiutong Chen2
1Department of Endocrinology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Objective:
To compare dapagliflozin versus acarbose as adjuncts to insulin on continuous glucose monitoring (CGM)-derived time in range (TIR), glycemic variability, and safety in adults with type 1 diabetes (T1DM).
Methods:
In this prospective, randomized, open-label, crossover trial, adults with T1DM (aged 18-60 years, glycated hemoglobin ≤ 9.0%) received dapagliflozin (10 mg once daily) and acarbose (50 mg 3 times daily), each for 4 weeks with a 2-week washout. Blinded CGM was worn during the final 14 days of each period. The primary endpoint was TIR (3.9-10.0 mmol/L).
Results:
Forty-four participants completed both periods. Dapagliflozin significantly increased TIR from baseline (55.4% to 68.2%; P < .001) and reduced mean glucose and glycemic variability (standard deviation of blood glucose, largest amplitude of glycemic excursions; P < .01). Acarbose reduced postprandial glucose excursions (P = .001). Compared directly with acarbose, dapagliflozin achieved a higher TIR (68.2% vs 56.0%; P < .001) and resulted in a lower total daily insulin dose during treatment (31.94 U vs 35.63 U; P = .001). Notably, only dapagliflozin was associated with a significant reduction in insulin requirements from baseline (31.94 U vs 38.45 U, P = .009). Hypoglycemia frequency did not differ between treatments (P = .467), and no diabetic ketoacidosis events occurred.
Conclusions:
In this short-term controlled study of adults with T1DM, adjunctive dapagliflozin was associated with improved CGM-derived glycemic control and reduced insulin dose versus acarbose, without diabetic ketoacidosis events. Longer term studies are warranted.
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