Effect of switching from pioglitazone to the sodium glucose co‐transporter‐2 inhibitor dapagliflozin on body weight and metabolism‐related factors in patients with type 2 diabetes mellitus: An open‐label, prospective, randomized, parallel‐group comparison trial

The effects of dapagliflozin (DAP) and pioglitazone (PIO) on body weight and glycaemic control were compared in patients with type 2 diabetes mellitus. Seventy‐one patients on PIO were either switched to DAP (n = 36) at 5 mg per day or continued on PIO (n = 35). Primary endpoints were superiority of body weight loss and non‐inferiority of HbA1c level after 24 weeks with DAP. Body weight decrease was greater with DAP than with PIO (75.3 ± 14.9 to 71.3 ± 15.1 kg vs. 74.7 ± 13.8 to 75.2 ± 13.9 kg; P < 0.01). Change in the HbA1c level was comparable (P = 0.64). The level of N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) and urinary albumin : creatinine ratio (ACR) decreased only with DAP (NT‐proBNP, P < 0.01; ACR, P = 0.02), and the change in NT‐proBNP correlated negatively with baseline NT‐proBNP level (ρ = −0.68, P < 0.01) and log‐converted ACR (ρ = −0.35, P < 0.05). DAP promotes body weight loss in type 2 diabetes mellitus and may decrease fluid retention, thus reducing the occurrence of cardiovascular events.