Is an SGLT2i better than metformin as first line in T2D?

23rd August 2022

SGLT2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with type 2 diabetes (T2D) and high cardiovascular risks as well as in patients with chronic kidney disease and heart failure regardless of diabetes status and independently of blood glucose levels or HbA1c. At present, we can only initiate an SGLT2 inhibitors after metformin. In other words, only as second-line after metformin and if the HbA1c is > 7%.

Is an SGLT2 inhibitor any good when used as first line agent in reducing progression of renal disease in patients with T2D? START is a NHMRC-funded clinical trial that will evaluate the comparative effects of the Sodium Glucose Co-Transporter 2 (SGLT2) inhibitor dapagliflozin compared to metformin, on annual decline in eGFR, when used as first-line therapy in people with newly diagnosed type 2 diabetes. This study is being coordinated by The George Institute for Global Health and Monash University.

Participation in this study offers general practices the opportunity to participate in research as well as the potential to contribute towards improving the health of their patients with type 2 diabetes. Financial remuneration ($150 per randomised participant) will be provided to general practices to support any administrative costs that may arise.