793-P: Dapagliflozin Improves Renal Function in Obese Indian Diabetics with Microalbuminuria

Abstract

SGLT2 inhibitors have gained appreciation following their acceptance as a treatment modality for people with type 2 diabetes. These agents promote glucosuia blocking the reabsorption of glucose from the proximal convoluted tubules in the kidneys. Due to the direct role on the nephrons, initially there were some concerns over their use among the renal compromised individuals. Urinary albumin to creatinine ratio (UACR) is considered as one of the indicators to access the renal function and to classify chronic kidney disease. RAAS blockers are the standard therapeutic options for reducing urinary albumin excretion among those with or without diabetes. This study aimed to find the renoprotective effect of dapagliflozin (DAPA) among obese Indian type 2 diabetics (T2D) with microalbuminuria and compared that with RAAS blockers. We considered 182 obese adults (BMI ≥30 kg/m2) with T2D and microalbuminuria for this study. Subjects were randomized into 2 groups. Those in DAPA group (n = 86, M/F: 51/35) were administered DAPA 10 mg once daily with breakfast, whereas subjects in the comparator (RAAS) arm (n = 96, M/F 54/42) were prescribed RAAS blockers (ARBs or ACE inhibitors). From comparable UACR and HbA1c at baseline, both groups witnessed a significant decline in the UACR at 12 weeks of intervention (p<0.02). The change in the UACR from baseline was higher in the DAPA arm, though it was not statistically different from RAAS arm (145.7± 32.8 to 89.5 ± 35.8 mg/g vs. 131.5 ± 44.6 to 94.3 ± 28.2 mg/g). Additionally, DAPA arm in contrast to RAAS arm, proved their glycemic benefits by demonstrating a significant reduction in the HbA1c (1.5 ± 1.2% vs. 0.3 ± 0.6%). There was a drop in blood pressure in the study and comparator arms, but RAAS agents were found to be more effective in lowering blood pressure (P <0.03). Dapagliflozin exhibited significant and numerically better reduction in UACR compared to RAAS blocking agents among obese microalbuminuric diabetics. Use of dapagliflozin also resulted in significant Hba1c reduction. Disclosure H. Mahapatra: None. L. Mahapatra: None. M. Khuntia: None. A. K. Sahoo: None.