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

• 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:

• NICE (November 2016). Dapagliflozin in combination therapy for treating type 2 diabetes
• NICE (November 2016). Dapagliflflozin in triple therapy for treating type 2 diabetes