Short-term effectiveness of dapagliflozin versus DPP-4 inhibitors in elderly patients with type 2 diabetes: a multicentre retrospective study
Authors: Morieri M. L. , Raz I. , Consoli A. , Rigato M. , Lapolla A. , Broglio F. , Bonora E. , Avogaro A. , Fadini G. P. ,   for the DARWIN-FUP network, Ginestra Federica , Formoso Gloria , Consoli Agostino , Andreozzi Francesco , Sesti Giorgio , Turco Salvatore , Lucibelli Luigi , Gatti Adriano , Aldigeri Raffaella , Dei Cas Alessandra , Felace Giuseppe , Li Volsi Patrizia , Sorice GianPio , Giaccari Andrea , Mignogna Carmen , Buzzetti Raffaella , Filardi Tiziana , Morano Susanna , Barchetta Ilaria , Gisella Cavallo Maria , Malandrucco Ilaria , Frontoni Simona , Carletti Silvia , D’Angelo Paola , Leto Gaetano , Leonetti Frida , Silvia Morpurgo Paola , Fiorina Paolo , Palmieri Eva , Orsi Emanuela , Mantovani Enzo , Franzetti Ivano , Querci Fabrizio , Bossi Antonio , Turchi Federica , Manfrini Silvana , Guida Danila , Placentino Giuseppe , Beccuti Guglielmo , Broglio Fabio , Cavalot Franco , Nuzzo Alessandro , Aimaretti Gianluca , Lamacchia Olga , Cignarelli Angelo , Laviola Luigi , Giorgino Francesco , Devangelio Eleonora , Cazzetta Giuliana , Chianetta Roberta , Citarrella Roberto , Tumminia Andrea , Frittitta Lucia , Anzaldi Massimiliano , Buscema Massimo , Piro Salvatore , Di Pino Antonino , Purrello Francesco , Di Benedetto Antonino , Russo Giuseppina , Anichini Roberto , Solini Anna , Garofolo Monia , Del Prato Stefano , Fattor Bruno , Paolo Fadini Gian , Avogaro Angelo , Lapolla Annunziata , Sartore Giovanni , D’Ambrosio Michele , Da Tos Virgilio , Frison Vera , Simioni Natalino , Cigolini Massimo , Bonora Enzo , Brun Elisabetta , Strazzabosco Marco , Poli Maurizio , Rigato Mauro , Paccagnella Agostino , Vinci Carmela 
Published: January 2023

Abstract
Aim
To compare effectiveness of dapagliflozin versus DPP-4 inhibitors on individualized HbA1c targets and extra-glycaemic endpoints among elderly patients with type 2 diabetes (T2D).

Methods
This was a multicentre retrospective study on patients aged 70–80 years with HbA1c above individualized target and starting dapagliflozin or DPP-4 inhibitors in 2015–2017. The primary outcome was the proportion reaching individualized HbA1c targets. Confounding by indication was addressed by inverse probability of treatment weighting (IPTW), multivariable adjustment (MVA), or propensity score matching (PSM).

Results
Patients initiating dapagliflozin (n = 445) differed from those initiating DPP-4i (n = 977) and balance between groups was achieved with IPTW or PSM. The median follow-up was 7.5 months and baseline HbA1c was 8.3%. A smaller proportion of patients initiating dapagliflozin attained individualized HbA1c target as compared to those initiating DPP-4 inhibitors (RR 0.73, p < 0.0001). IPTW, MVA, and PSM yielded similar results. Between-group difference in the primary outcome was observed among patients with lower eGFR or longer disease duration. Dapagliflozin allowed greater reductions in body weight and blood pressure than DPP-4 inhibitors.

Conclusions
Elderly patients with T2D initiating dapagliflozin had a lower probability of achieving individualized HbA1c targets than those initiating DPP-4 inhibitors but displayed better improvements in extra-glycaemic endpoints.