COMPARATIVE EFFICACY OF PIOFLITAZONE AND DAPAGILFLOZIN IN REDUCTION OF DIABETIC NEPHROPATHY

Abstract

Background: 

Diabetic nephropathy is a major complication of type 2 diabetes. This study aimed to compare the renoprotective efficacy of pioglitazone (a thiazolidinedione) and dapagliflozin (an SGLT2 inhibitor) in patients with established diabetic nephropathy.

Methods: 

In this six-month, prospective, comparative cross sectional, open-label trial, 150 patients were assigned to receive either pioglitazone 30 mg/day (n=75) or dapagliflozin 10 mg/day (n=75), alongside standard care. The primary outcome was the percentage change in urinary albumin-to-creatinine ratio (UACR). Secondary outcomes included changes in estimated glomerular filtration rate (eGFR), HbA1c, blood pressure, and body weight.

Results:

Dapagliflozin demonstrated significantly greater reduction in UACR compared to pioglitazone (37.5% vs. 22.8%, p<0.001). Furthermore, the dapagliflozin group showed a modest improvement in eGFR (+1.8 mL/min/1.73 m²), while the pioglitazone group experienced a decline (-2.1 mL/min/1.73 m²; p<0.001). Dapagliflozin also provided superior benefits in glycemic control (HbA1c reduction: -1.2% vs. -0.9%, p=0.002), systolic/diastolic blood pressure, and body weight reduction (p<0.001). Adverse events differed: pioglitazone was associated with edema and weight gain, whereas dapagliflozin was linked to genitourinary infections.

Conclusion: 

Over a six-month period, dapagliflozin was more effective than pioglitazone in reducing albuminuria and preserving renal function, while also offering better metabolic and hemodynamic outcomes. These findings support the use of dapagliflozin as a superior renoprotective agent in patients with type 2 diabetic nephropathy.