Nice | Dapagliflozin for Type 2 Diabetes

This guideline advises that Dapagliflozin can be used in Type 2 Diabetes as add-on therapy:
• With metformin if:
- glycaemic control is not adequate
- a sulphonylurea can not be used
- its addition gives a 0.5% or more drop in HbA1c at 6 months
• In combination with insulin, with or without other drugs
• In triple therapy only as part of a clinical trial.

Never heard of this drug? Me neither. It's an SGLT-2 (sodium-glucose cotransporter 2 inhibitor). If that doesn't make it all clear, it works by both blocking reabsorption of glucose in the kidneys and by increasing excretion. This guideline looks at combination therapy, but it is also licensed for monotherapy where metformin can't be used.

Contraindications: Among others, it's action is dependant on adequate renal function, so it shouldn't be used if GFR is < 60. It should not be used with pioglitazone.
Side-effects: Among others, it can cause hypoglycaemic if used with insulin or sulphonylureas.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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