Summary: In overweight or obese adults with type 2 diabetes of less than 6 years duration, dapagliflozin 10 mg/day added to regular calorie restriction increased 12-month diabetes remission versus calorie restriction alone, 44% versus 28% (risk ratio 1.56, 95% CI 1.17-2.09; P=0.002), without a significant adverse-event difference.
PICO Summary
| Element | Detail |
|---|---|
| Population | 328 overweight or obese adults in China aged 20-70 years with type 2 diabetes duration <6 years; multicentre, double-blind, placebo-controlled RCT across 16 centres. |
| Intervention | Regular calorie restriction plus dapagliflozin 10 mg/day (n=165). |
| Comparison | Regular calorie restriction plus placebo (n=163). |
| Outcome | Diabetes remission at 12 months occurred in 44% (73/165) versus 28% (46/163); risk ratio 1.56 (95% CI 1.17-2.09; P=0.002), absolute difference 16 points, NNT about 7. Body weight was 1.3 kg lower (95% CI -1.9 to -0.7), and HOMA-IR was 0.8 lower (95% CI -1.1 to -0.4). |
Dapagliflozin + Diet for T2D Remission
Multicentre RCT - early T2D + overweight - 12 months
Adding dapagliflozin to calorie restriction increased 12-month diabetes remission versus calorie restriction alone, without a significant adverse-event difference.
Expert Commentary
This is a clinically useful remission trial because it tests an accessible pharmacologic adjunct to structured weight loss in relatively early type 2 diabetes. Adding dapagliflozin to calorie restriction increased 12-month remission from 28% to 44%, an absolute gain of 16 percentage points, which is clinically meaningful and corresponds to an NNT of about 7. The parallel improvements in weight, insulin resistance, blood pressure, and metabolic risk markers make the result biologically coherent. The main limitation is generalisability: participants were overweight or obese adults from China with diabetes duration under 6 years, and remission required only two months off glucose-lowering drugs, so durability beyond 12 months remains uncertain. Safety is reassuring because adverse events were not significantly different between groups, but this was not a hard-outcomes trial and the intervention still requires dietary adherence and follow-up. Can I use this with my patients? Yes, in selected adults with early type 2 diabetes, excess weight, preserved renal function, and strong motivation for structured calorie restriction, this supports considering dapagliflozin as part of a remission-oriented strategy rather than glucose lowering alone. I would still frame remission as conditional, monitor volume status and genital or urinary adverse effects, and push for longer follow-up data on durability and relapse.
References
Liu Y, Chen Y, Ma J, et al. Dapagliflozin plus calorie restriction for remission of type 2 diabetes: multicentre, double blind, randomised, placebo controlled trial. BMJ. 2025;388:e081820. doi:10.1136/bmj-2024-081820. PMID: 39843169.