Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects

1. SGLT2I – Changing Paradigms
in T2DM management
The Dual friendly drug
Dr. Nagula Praveen
MD,DM (Cardiology)
Osmania General Hospital, Hyderabad

2. Diabetes Mellitus
A complex, chronic illness requiring continuous medical care with
multi-factorial risk-reduction strategies BEYOND GLYCEMIC CONTROL
Diabetes Care 2015;38(Suppl. 1):S1–S2 | DOI: 10.2337/dc15-S001

3. International Diabetes Federation
IDF Diabetes Atlas 9th edition, 2019

4. IDF Diabetes Atlas 9th edition, 2019
Global Scenario
463 mnDiabetes
Population
9.3%
Prevalence
International Diabetes Federation

5. IDF Diabetes Atlas 9th edition, 2019
Global Scenario
463 mnDiabetes
Population
9.3%
Prevalence
8.9%
Prevalence
77 mn
Diabetes Population
International Diabetes Federation
India : The second largest home of Diabetes

6. Risk continuum of T2DM
• CVD
• HF
• CKD
• Leading to death
The Continuum of Cardio-Renal-Metabolic (CRM) Risk
Adv Chronic Kidney Dis. 2014 May; 21(3): 273–280 T2DM : Type 2 Diabetic Mellitus; CVD – Cardio Vascular Diseases; HF – Heart Failure CKD – Chronic Kidney Diseases; CV: Cardio Vascular; MI: Myocardial Infarction; LV: Left Ventricular

7. BMJ 2000;321:405-412 UKPDS : UK Prospective Diabetes Study; HbA1c: Glycosylated Hemoglobin
UKPDS : Intensive Glycemic Control Is Essential To Improve
Micro-Vascular & Macro-Vascular Outcomes
Every 1% HbA1c
Reduction
Death due to Diabetes
Heart Attack
Microvascular Complication
Peripheral Vascular Disorders
-21%
-14%
-37%
-43%

8. OAD Treatment Goal : Benefits Beyond Glycemic Control
• Keep blood glucose levels near to normal or recommended target range
• Prevent or delay the progression of micro / macro vascular complications
• Decrease morbidity and mortality related to DM
• Ensure a good quality life
Rev Esp Cardiol 2002;55(8):845-60; OAD: Oral Anti-Diabetics DM – Diabetes Mellitus

9. Insulin
Biguanide
Sulfonylureas
Meglitinides
DPP4i
Alpha-Glucosidase Inhibitors
Glitazones
Current Therapy Focus : Insulin Dependent MOA
Limitations
Hypoglycemia
Weight Gain
Beta Cell Fatigue
GI Side Effects
Reluctance : Injection
https://www.ncbi.nlm.nih.gov/books/NBK279141/ ; DPP4i - Dipeptidyl Peptidase-4 Inhibitor; MOA: Mode Of Action; GI: Gastro Intestinal

10. Ability to
Lower Glucose
Risk of
Hypoglycemia
Weight
Change
Effect on
ASCVD
Effect on
CHF
Effect on Renal
Disease
Biguanide High No
Modest
weight loss
Potential
Benefit
Neutral Neutral
Glitazones High No Increase
Potential
Benefit
Potential
Benefit
Neutral
AGI Intermediate No Neutral Neutral Neutral Neutral
DPP4i Intermediate No Neutral
Potential
Benefit
Potential
Benefit
Neutral
SUs High Yes Increase Neutral Neutral Neutral
Insulin High Yes Increase Neutral Neutral Neutral
Effects of Glucose-Lowering Therapies
on Cardio-Metabolic Risk Factors
https://www.ncbi.nlm.nih.gov/books/NBK279141/ Nov-Dec 2017;60(3):422-434. doi: 10.1016/j.pcad.2017.09.001 AGI - Alpha-glucosidase inhibitors; DPP4i - Dipeptidyl peptidase-IV (DPP-4) inhibitors;
SUs – Sulfonylureas; CHF: Congestive Heart Failure; ASCVD: Athero Sclerotic Cardio Vascular Disease

11. Ability to
Lower Glucose
Risk of
Hypoglycemia
Weight
Change
Effect on
ASCVD
Effect on
CHF
Effect on Renal
Disease
Biguanide High No
Modest
weight loss
Potential
Benefit
Neutral Neutral
Glitazones High No Increase
Potential
Benefit
Potential
Benefit
Neutral
AGI Intermediate No Neutral Neutral Neutral Neutral
DPP4i Intermediate No Neutral
Potential
Benefit
Potential
Benefit
Neutral
SUs High Yes Increase Neutral Neutral Neutral
Insulin High Yes Increase Neutral Neutral Neutral
Effects of Glucose-Lowering Therapies
on Cardio-Metabolic Risk Factors
https://www.ncbi.nlm.nih.gov/books/NBK279141/ Nov-Dec 2017;60(3):422-434. doi: 10.1016/j.pcad.2017.09.001 AGI - Alpha-glucosidase inhibitors; DPP4i - Dipeptidyl peptidase-IV (DPP-4) inhibitors;
SUs – Sulfonylureas; CHF: Congestive Heart Failure; ASCVD: Athero Sclerotic Cardio Vascular Disease
Although several glucose-lowering drugs have been widely used, cardio-renal complications
attract considerable attention!!!
Therefore, the drugs that provide cardio-renal protection is desired
Thus, SGLT2i can be considered

12. SGLT : Distribution & Function
Ni et al. Cardiovasc Diabetol (2020) 19:98 ; SGLT: Sodium–Glucose Co-Transporter

13. SGLT : Distribution & Function
SGLT1 : High-affinity, low-volume membrane transporter & performs 10% of glucose
re-absorption
SGLT2 : Low-affinity, high-volume membrane transporter & performs 90% of glucose
re-absorption
Ni et al. Cardiovasc Diabetol (2020) 19:98 ; SGLT: Sodium–Glucose Co-Transporter

14. Glucose filtration
Loop
of
Henle
SGLT2 SGLT1
Glomerulus Proximal tubule Distal tubule Collecting duct
No glucose
excretion
Glucose
reabsorption
90% 10%
Normal Glucose Homeostasis
SGLT2 : Expression & Pharmacological Action
Approximately 160g–180g glucose is filtered from the glomerulus & reabsorbed into
the blood circulation. No urinary glucose excretion observed in healthy individuals
Ni et al. Cardiovasc Diabetol (2020) 19:98 ; SGLT: Sodium–Glucose Co-Transporter

15. Glucose filtration
Loop
of
Henle
SGLT2 SGLT1
Glomerulus Proximal tubule Distal tubule Collecting duct
Glycosuria
Increased Glucose
reabsorption
90% 10%
Diabetes Mellitus
SGLT2 : Expression & Pharmacological Action
Approximately 180g– 240g glucose reaches glomerulus for filtration. This level is much higher
than the renal glucose threshold (200 g/dl) due to which SUGAr FLOws out of the urine
Ni et al. Cardiovasc Diabetol (2020) 19:98 ; SGLT: Sodium–Glucose Co-Transporter

16. SGLT2i : Mechanism of Action
SGLT2i reduces the
glucose re-absorption
in the proximal tubule,
thus SUGAr FLOws
out of the body
Ni et al. Cardiovasc Diabetol (2020) 19:98 ; SGLT: Sodium–Glucose Co-Transporter

17. 1987
Non-selective against SGLT2/SGLT1
O-Glucoside structure :
Unstable, rapidly degrading
2013
>250 fold SGLT2 selectivity
C-Glucoside structure :
makes stable in small intestine
Jan
2014
>1200 fold SGLT2 selectivity
C- Glucoside structure
Aug
2014
>2500 fold SGLT2 selectivity
C- Glucoside structure
SGLT2i : Evolution
SGLT: Sodium–glucose co-transporter.

18. • T2DM treatment
8th Jan 2014
• T2DM with hHF
21st Oct 2019
• HF patients with HFrEF
6th May 2020
• CKD by USFDA
30th Apr 2021
Dapagliflozin : Regulatory Timelines
US FDA & EU Regulatory Approval; T2DM: Type 2 Diabetic Mellitus; hHF: Hospitalization due to Heart Failure, HFrEF – Heart Failure with Reduced Ejection Fraction; CKD: Chronic Kidney Disease

19. Diabetes Care. 2015;38:2009-2017; DM: Diabetes Mellitus; T2DM: Type 2 Diabetic mellitus; OAD: Oral Anti Diabetics; T1DM: Type 1 Diabetic mellitus
Dapagliflozin : Therapy Placement In DM
Glycemic control with moderate weight loss & least risk of hypoglycemia
In T2DMs with or without co-morbid condition
• Adjunct to diet and exercise
• Alternative / add-on to existing OADs or Insulin
Under regulatory consideration
• Ideal adjuvant to Insulin in T1DMs

20. In DM with
• Patients not achieving targeted HbA1c
• Overweight & Obese patients
• CVD & CKD patients with eGFR>45
• High risk of hypoglycemia (v/s Insulin / SUs)
Curr Opin Endocrinol Diabetes Obes. 2017 Feb; 24(1): 73–79; DM: Diabetes Mellitus; HbA1c: Glycosylated Hemoglobin; CVD: Cardio Vascular Disease CKD: Chronic Kidney Disease; eGFR: Estimated Glumerular Filteration Rate; SUs: Sulfonyl Ureas
Dapagliflozin : Ideal Patient Profile
Ideal Profile

21. SGLT2 Inhibitors: Do They All Work the Same Way?
Drug (dose)
Half-life
(hours)
Oral
bioavailability (%)
Volume of
distribution
(L)
Plasma protein
binding (%)
Metabolism and
elimination
SGLT2 selectivity
(vs SGLT1)
Canagliflozin
(100–300 mg OD)
10.6–
13.1
65 83.5 98
Hepatic
conjugated
Renal excretion
~ 250 fold
Dapagliflozin
(5–10 mg OD)
12.9 78 118 91
Hepatic
conjugated
Renal excretion
~ 1200 fold
Empagliflozin
(10–25 mg OD)
12.4 60 73.8 86.2
Hepatic
conjugated
Renal excretion
~ 2500 fold
Diabetes Therapy volume 12, pages55–70 (2021); SGLT: Sodium–Glucose Co-Transporter; OD: Once Daily

22. Dapagliflozin v/s Other SGLT2i : Clinical Efficacy
SGLT2i: Sodium–glucose co-transporter2 inhibitor; HbA1c; Glycosylated Hemoglobin

23. Kluger et al. Cardiovasc Diabetol (2019) 18:99; SGLT2i: Sodium–Glucose Co-Transporter 2 Inhibitor; hHF: Hospitalization due to Heart failure; CV: Cardio Vascular; Mace: Major Adverse Cardiac Events; ESRD: End Stage Renal Disease
Dapagliflozin v/s Other SGLT2i : Cardio-renal Safety
Lowest incidences of ESRD
progression
Lowest incidences of hHF, CV
death & MACE

24. Landmark Clinical Trials
DAPA – HF
DECLARE TIMI-58
DAPA-CKD

25. N Engl J Med 381;21; DM: Diabetes Mellitus
DAPA – HF TRIAL
Objective: To evaluate the efficacy and safety of
Dapagliflozin patients with heart failure and a reduced
ejection fraction, REGARDLESS OF PRESENCE OR ABSENCE
OF DM
4,744
patients
Randomized, double
blind, placebo
controlled trial
Mean Duration of
follow up : 18.2
months

26. N Engl J Med 381;21; HF: Heart Failure; CV: Cardiovascular; KCCQ: Kansas City Cardiomyopathy Questionnaire; ESRD: End Stage Renal Disease
DAPA – HF TRIAL
Primary outcomes :
Composite: worsening HF or CV death
• Worsening HF = unplanned hospitalization or an urgent visit
resulting into heart failure
Secondary outcomes :
Composite: HF hospitalization or CV death
• Each component alone
• KCCQ: change from baseline to 8 months
• Composite: worsening renal function, ESRD or renal death
Safety outcomes :
Serious adverse events

27. N Engl J Med 381;21
DAPA – HF TRIAL

28. N Engl J Med 381;21; CV: Cardiovascular; HF: Heart Failure; KCCQ: Kansas City Cardiomyopathy Questionaire
DAPA – HF TRIAL
Objective: To evaluate the efficacy and safety of Dapagliflozin
patients with heart failure and a reduced ejection factor,
regardless of presence or absence of diabetic

29. DECLARE-TIMI
Dapagliflozin Effect on CardiovascuLAR Events
A multi-national, randomized, double-blind, placebo-controlled Phase IIIB trial jointly
led by the TIMI Study Group and Hadassah Medical Center
To determine the effect of Dapagliflozin on CV outcomes
when added to current background therapy in patients with
T2DM with either established CVD / CV risk factors.
17,190
Patients
Multicenter,
Randomized, Double-
Blind, Placebo-
Controlled Trial
4.2 Years
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis in Myocardial Infarction; CV: Cardiovascular; T2DM: Type 2 Diabetes Mellitus;

30. DECLARE-TIMI
Eligible
T2DM
patients
With HbA1c 6.5% - 12.0% & Creatinine clearance of
60ml or more per minute
With multiple risk factors for ASCVD or had a
established ASCVD
With one or multiple risk factors ie. HT,
dyslipidemia or patients using lipid lowering
therapies
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis in Myocardial Infarction; T2DM: Type 2 Diabetes Mellitus; HbA1c: Glycosylated Hemogloblin; ASCVD: Athero Sclerotic Cardio Vascular Disease; HT: Hypertension

31. DECLARE-TIMI
Primary Safety Outcomes
• CV death, Myocardial Infraction or Ischemic Stroke
Secondary Efficacy Outcomes:
• ≥40% decrease eGFR to <60 ml/Min/1.73m2 of body surface area
• New end stage renal disease
• Death from renal or cardiovascular causes & death from any cause
Primary Efficacy Outcomes
• MACE & composite of CV death or hospitalization for Heart Failure
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis In Myocardial Infarction; CV: Cardio Vascular; MACE: Major Adverse Cardiac Events

32. DECLARE-TIMI
Dapagliflozin : 4.9%
Placebo : 5.8%
CV death / hHF:
Dapagliflozin
provides 1%
reduction in CV
death or hHF vs
placebo
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis In Myocardial Infarction; CV: Cardio Vascular; hHF: Hospitalization due to Heart Failure

33. DECLARE-TIMI
Dapagliflozin : 8.8%
Placebo: 9.4%
MACE Outcome:
Lower incidences
of MACE vs
Placebo
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis In Myocardial Infarction; MACE: Major Adverse Cardiac Events

34. DECLARE-TIMI
Dapagliflozin : 4.3%
Placebo: 5.6%
Renal Outcomes
Favorable renal
outcome over
placebo
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis In Myocardial Infarction;

35. DECLARE-TIMI
Offers robust & consistent effects on
the prevention of heart failure &
renal outcomes
N Engl J Med 2019; 380:347-357; TIMI: Thrombolysis In Myocardial Infarction; hHF: Hospitalization due to Heart Failure; CV: Cardio Vascular

36. Objective: To assess whether Dapagliflozin compared with placebo
reduces the composite endpoint of worsening of renal function (eGFR
decline >50%, ESRD or renal death) or cardiovascular death in patients
with CKD
N= 2,152
N= 2,152
eGFR: Estimated Glomerular Filteration rate; ESRD: End stage Renal Disease; CKD: Chronic Kidney disease
DAPA CKD

37. Primary Outcomes
The first occurrence of any of the following:
• Decline of at least 50% in eGFR
• Onset of ESRD
• Kidney transplantation
• Death from renal or cardiovascular causes
Secondary Outcomes
• Sustained decline in the eGFR of at least 50%,
• ESRD
• Death due to renal impairment
• Composite CV outcome ie. hHF, Death from CV cause / any cause
eGFR: Estimated Glomerular Filteration Rate; ESRD: End Stage Renal Disease; CV: Cardio Vascular; hHF: Hospitalization due to Heart Failure
DAPA CKD

38. 39% RRR for the primary composite endpoint (≥50%
sustained decline in eGFR, ESKD, renal or CV death)
eGFR: Estimated Glomerular Filteration Rate; ESKD: End stage Kidney Disease; CV: Cardio Vascular; RRR: Relative Risk Reduction; HR: Hazard Ratio
DAPA CKD

39. 44% RRR for the renal composite (≥50% sustained decline
in eGFR, ESKD, or renal death)
HR: Hazard Ratio eGFR: Estimated Glomerular Filteration rate; ESKD: End Stage Kidney Disease; RRR: Relative Risk Reduction
DAPA CKD

40. 29% RRR for the composite of CV death or hospitalization
for heart failure
RRR: Relative Risk Reduction; HR: Hazard Ratio; CV: Cardiovascular
DAPA CKD

41. 31% RRR all-cause
mortality
RRR: Relative Risk Reduction
DAPA CKD

42. Significant cardio-renal
protective effect
eGFR: Esteemed Glomerular Filteration Rate
DAPA CKD

43. Reduces cardio-renal risks in patients with/without DM
https://www.grepmed.com/images/12169/ebm-table-inhibitors-cvd-visualabstract CV: Cardio Vascular; HHF: Hospitalization due to Heart Failure; MACE: Major Adverse Cardiac Event; T2DM: Type 2 Diabetes Mellitus; ASCVD: Athero Sclerotic Cardio
Vascular Disease; CKD: Chronic Kidney Disease, eGFR: Estimated Glomerular Filteration Rate; ESKD: End Stage Kidney Disease; GDMT: Guideline Directed Medical Therapy; HFrEF: Heart Failure reduced Ejection Fraction; DM: Diabetes Mellitus
Quick Snapshot: Dapagliflozin Landmark Trials
Hazard
Ratio

44. 1- Diabetes Care, Volume 33, Number 10, October 2010; 2- Ther Adv Drug Saf. 2014 Dec; 5(6): 242-254; 3- Diabetes Care, Volume 38, March 2015; 4- Diabetes, Obesity & Metabolism 17:616-621, 2015; 5-Sci Rep. 2019; 9:6864; HbA1c:
Glycosylated Hemoglobin; SUs: Sulfonylureas; Met: Metformin DPP4i: Dipeptidyl Peptidase 4 inhibitor; OADs: Oral Anti Diabetics
Dapagliflozin : Glucose Lowering Effect
Sugar flowsout of the urine thus offering glycemic control

45. SGLT2i action becomes negligible when the plasma glucose concentration
drops below 90 mg/dL
Dapagliflozin : Low Incidences of Hypoglycemia
1- Diabetes Care, Volume 33, Number 10, October 2010; 2- Bailey et al. BMC Medicine 2013, 11:43; 3- Diabetes Care, Volume 38, March 2015; 4- Diabetes, Obesity & Metabolism 17:616-621, 2015; 5- Sci Rep. 2019; 9:6864; SGLT2i: Sodium Glucose
Co-Transporter 2 Inhibitor; SUs: Sulfonylureas; Met: Metformin; DPP4i: Dipeptidyl Peptidase 4 inhibitor

46. Dapagliflozin induces 200-300 calorie loss/day as sugar flows out of the
urine, thus resulting in weight reduction
Dapagliflozin : Body Weight Change
1- Diabetes Care, Volume 33, Number 10, October 2010; 2- Ther Adv Drug Saf. 2014 Dec; 5(6): 242-254; 3- Diabetes Care, Volume 38, March 2015; 4- Diabetes, Obesity & Metabolism 17:616-621, 2015; 5- Indian Journal Of Endocrinology &
Metabolism, Vol 22, Issue 6, November-December 2018; SUs: Sulfonylureas; DPP4i: Dipeptidyl Peptidase 4 inhibitor; Met: Metformin ; OADs: Oral Anti Diabetics

47. Sugar flows through urine along with sodium,
leading to modest SBP reduction
Dapagliflozin : SBP Reduction
1- Diabetes Care, Volume 33, Number 10, October 2010; 2- Bailey et al. BMC Medicine 2013, 11:43; 3- Diabetes Care, Volume 38, March 2015; 4- Scientific Reports, (2018) 8:4466, DOI:10.1038, s41598-018-22658-2; 5- Copyright @2019 Korean
Endocrine Society; SBP: Systolic Blood Pressure; SGLT2i: Sodium Glucose Co-Transporter 2 Inhibitor; SUs: Sulfonylureass Met: Metformin; DPP4i: Dipeptidyl Peptidase 4 inhibitor; OADs: Oral Anti Diabetics

48. SPC]. AstraZeneca UK Limited. 2015; LDL: Low Density Lipoprotein; HDL: High Density Lipoprotein
-1.0
2.7
-0.7
0.0
2.9
6.0
-2.7
2.5
-4
-2
0
2
4
6
8
10
Mean
change
from
baseline
(%)
Placebo Dapagliflozin 10 mg
LDL-C HDL-C Triglycerides Total cholesterol
Dapagliflozin : Favorable Lipid Profile
Positive effect on lipid triads

49. Dapagliflozin : Stable Renal Function Over 2 Years
ADA, 74th Scientific Session, June 13 - 17, 2014; San Francisco, California; eGFR: Estimated Glomerular Filteration Rate; MDRD: Modification of Diet in Renal Disease; T2DM: Type 2 Diabetes Mellitus
Stable Renal function over 2 years in
patients with T2DM

50. Dapagliflozin Add-on treatment: Significantly Reduced UACR
https://www.jocmr.org/tables/jocmr3419wt.htm; UACR: Urine Albumin Creatinine Ratio; SGLT2i: Sodium Glucose Co-Transporter 2 Inhibitor;
UACR Absolute
change : 0.82 mg/g
UACR Absolute
change : -3.7 mg/g
53.3% patients showed improved urine
albumin-to-creatinine ratio (UACR)

51. Dapagliflozin : Stable Insulin Dose Over 2 Years in T2DM
Diabetes, Obesity & Metabolism 16:124-136,2014; HbA1c: Glycosylated Hemoglobin; T2DM: Type 2 Diabetes Mellitus;
0.8% reduction in HbA1c, -0.9-1.4 kg weight reduction &
reduced hypoglycemia in T2DMs inadequately
controlled with high dose of Insulin

52. Dapagliflozin : Excellent Glycemic Control With Insulin Dose
Reduction in T1DM (52 Weeks Study)
Drugs (2019) 79:1877–1884; T1DM: Type 1 Diabetes Mellitus
8% - 14% insulin dose reduction

64. N Engl J Med 381;21
Dapagliflozin : Side Effect Profile

65. Proper Personal Hygiene to avoid any
UTI/fungal infections
Steps to prevent genital infections in patients on SGLT2i
Drink 2 glasses of water half an hour
before taking the dose
UTI: Urinary Tract Infection

66. Am I prescribing the
Right Dapagliflozin
formulation?
Dapagliflozin
Dapagliflozin
Dapagliflozin Propanediol Monohydrate
Dapagliflozin

67. European Journal of Pharmaceutical Sciences 104 (2017) 255–261; RH: Relative Humidity
Dapagliflozin : Amorphous in nature
Limitation :
Hygroscopicity : Uptakes 7.4% moisture at 95% RH
Poor thermal stability : Low melting point : 24.7 0C
Results into
Poor solid state stability i.e accuracy of weighing,
uniformity of mixtures with excipients

68. European Journal of Pharmaceutical Sciences 104 (2017) 255–261; RH: Relative Humidity
Dapagliflozin : Amorphous in nature
Limitation :
Hygroscopicity : Uptakes 7.4% moisture at 95% RH
Poor thermal stability : Low melting point 24.7 0C
Results into
Poor solid state stability i.e accuracy of weighing,
uniformity of mixtures with excipients
To compensate for these properties, immediate release tablets
consisting of DAP with Propanediol and water (Dapagliflozin Propanediol Monohydrate)
were manufactured

69. • DAP exhibits high hygroscopicity and it uptakes
7.4% water at 95% RH at 250C
In contrast, DAP-PDO-H2O uptakes 2% water at 95%
RH at 250C
• As compared to the amorphous DAP,
DAP-PDO-H2O has a multi-component crystal
structure leading to improved solubility leading to
better BA
US FDA & EMA have given approval for Dapagliflozin Propanediol
Monohydrate NOT TO DAPAGLIFLOZIN. All international studies
are conducted with Dapagliflozin Propanediol Monohydrate
NOT WITH DAPAGLIFLOZIN
European Journal of Pharmaceutical Sciences 104 (2017) 255–261; DAP: Dapagliflozin; BA: Bio Availability; RH: Relative Humidity; USFDA: United States Food and Drug Administration; EMA: European Medical Association

70. Cardio-Reno protective benefits : Confirmed by 3 major landmark studies
T2DMs : Effective glycemic control as a monotherapy / add-on therapy
T1DMs : Reduces insulin dose & offers additional glycemic control
High safety profile: Least hypoglycemic incidences with reduction in
weight & SBP
Dapagliflozin Propanediol Monohydrate: Proven stable formulation with
3 years stability data
Drugs 2019 79:1135-1146; T2DM: Type 2 Diabetes Mellitus; T1DM: Type 1 Diabetes Mellitus; SBP: Systolic Blood Pressure
SGLT2 i