Is Farxiga (dapagliflozin) effective for patients with type 2 diabetes, impaired renal function, and weight loss?

Farxiga (Dapagliflozin) for Diabetes, Kidney Disease, and Weight Loss

Farxiga (dapagliflozin) is strongly recommended for patients with type 2 diabetes who have kidney disease, as it significantly reduces kidney disease progression, cardiovascular events, and promotes weight loss. 1, 2

Benefits of Farxiga in Multiple Conditions

Glycemic Control

• Effectively lowers HbA1c by 0.4-0.6% in patients with type 2 diabetes 3, 4
• Works through an insulin-independent mechanism by inhibiting SGLT2 in the kidneys, causing urinary glucose excretion 3
• Can be used as monotherapy or add-on to other diabetes medications 1
• Glycemic benefits diminish when eGFR falls below 45 mL/min/1.73m² 2

Kidney Protection

• Provides significant renal protection regardless of baseline kidney function 2
• Reduces kidney disease progression by up to 44% in patients with CKD 2
• Can be initiated in patients with eGFR ≥20 mL/min/1.73m² 2
• Should be continued even if eGFR falls below 20 mL/min/1.73m² until kidney replacement therapy is needed 2
• Improves albuminuria status within 6 months of treatment 4

Cardiovascular Benefits

• Reduces hospitalization for heart failure (HR 0.73 [95% CI 0.61-0.88]) 2
• Provides cardiovascular protection even at lower eGFR levels 2
• Demonstrated cardiovascular safety in the DECLARE-TIMI 58 trial 1

Weight Loss

• Consistently produces weight loss of 1-2 kg over 24 weeks 3
• Weight reduction is maintained in long-term studies up to 2-4 years 5
• Weight loss effect is complementary to glycemic control 6

Dosing and Administration

Based on Renal Function

• Starting dose: 10 mg once daily for patients with eGFR ≥45 mL/min/1.73m² 2, 3
• For patients with eGFR 20-45 mL/min/1.73m²: Can be initiated or continued for cardiovascular and renal benefits, though glycemic effects will be reduced 2
• Contraindicated in patients with eGFR <15 mL/min/1.73m² or on dialysis 2

Administration

• Can be taken with or without food 3
• No dose adjustment needed based on age, gender, race, or body weight 3

Monitoring and Safety Considerations

Common Side Effects

• Genital mycotic infections (most common adverse effect, affecting ~6% of patients) 2
• Urinary tract infections (more frequent than with placebo) 3, 7
• Volume depletion (monitor especially when combined with diuretics) 2

Special Precautions

• Monitor renal function before initiation and periodically during treatment 2
• Watch for signs of diabetic ketoacidosis, especially in insulin-deficient patients 2
• Ensure proper genital hygiene to minimize infection risk 2
• Use with caution in patients with history of bladder cancer 7

Patient Selection Algorithm

1. For patients with T2DM and CKD (eGFR 20-60 mL/min/1.73m² and/or albuminuria):

   • Farxiga is strongly recommended for renal protection regardless of glycemic control needs 1, 2

2. For patients with T2DM and heart failure:

   • Farxiga is recommended to reduce hospitalization for heart failure and cardiovascular death 1, 2

3. For patients with T2DM needing weight loss:

   • Farxiga provides consistent weight reduction benefits alongside glycemic control 3, 6

4. For patients with T2DM without cardiovascular/renal disease:

   • Consider Farxiga as part of a treatment plan addressing both glycemic and weight goals 1

Clinical Pearls

• The benefits of Farxiga extend beyond glycemic control to include cardiorenal protection and weight loss
• Cardiovascular and renal benefits persist even when glycemic effects diminish at lower eGFR levels
• The low risk of hypoglycemia makes Farxiga particularly suitable for elderly patients or those at risk for hypoglycemia
• The unique mechanism of action makes it complementary to other diabetes medications
• Weight loss effects make it particularly valuable for patients with obesity and type 2 diabetes