Glipizide versus dapagliflozin efficacy
Pro Research Analysisby 
Searched over 200M research papers
Glycemic Control Efficacy: Dapagliflozin vs Glipizide in Type 2 Diabetes
Multiple studies show that dapagliflozin and glipizide have similar effectiveness in lowering blood sugar (HbA1c) when added to metformin in patients with type 2 diabetes who are not adequately controlled on metformin alone. Both drugs resulted in nearly identical reductions in HbA1c over 52 weeks, confirming that dapagliflozin is not inferior to glipizide for glycemic control 14. This finding is consistent across systematic reviews and randomized controlled trials 14.
Weight Change and Hypoglycemia Risk: Key Differences
While both drugs are equally effective at lowering HbA1c, their effects on body weight and hypoglycemia risk are very different. Dapagliflozin leads to significant weight loss, while glipizide is associated with weight gain. In one study, patients on dapagliflozin lost an average of 3.2 kg, whereas those on glipizide gained 1.2 kg . Additionally, a much higher proportion of patients achieved at least 5% body weight reduction with dapagliflozin compared to glipizide 14.
The risk of hypoglycemia is also much lower with dapagliflozin. Only 3.5% of patients on dapagliflozin experienced hypoglycemia, compared to 40.8% of those on glipizide . This makes dapagliflozin a safer option for patients at risk of low blood sugar episodes.
Renal and Metabolic Benefits
Dapagliflozin offers additional benefits for kidney health, especially in patients with glomerular hyperfiltration (a risk factor for kidney damage). Dapagliflozin, but not glipizide, was shown to normalize glomerular hyperfiltration and reduce renal vascular resistance, suggesting a protective effect on the kidneys . Dapagliflozin also reduced fasting plasma glucose, mean daily glucose, fasting insulin, and insulin resistance, and increased adiponectin, a marker of improved metabolic health .
Safety Profile and Adverse Events
Both drugs are generally well tolerated, but their side effect profiles differ. Dapagliflozin is associated with a higher rate of genital and urinary tract infections, but these are usually mild and respond to standard treatment . The rates of other adverse events, including hypoglycemia, are similar or lower with dapagliflozin compared to glipizide 16.
Cost-Effectiveness
When considering the combined goals of lowering HbA1c, avoiding hypoglycemia, and achieving weight loss, dapagliflozin plus metformin is more cost-effective than glipizide plus metformin. The cost of treating one patient to these combined endpoints is significantly lower with dapagliflozin, mainly because more patients reach these goals and there are fewer costly adverse events like hypoglycemia .
Conclusion
Dapagliflozin and glipizide are equally effective at lowering blood sugar in type 2 diabetes patients inadequately controlled on metformin. However, dapagliflozin offers important advantages: it promotes weight loss, has a much lower risk of hypoglycemia, may protect kidney function, and is more cost-effective when multiple treatment goals are considered. The main trade-off is a higher risk of mild genital and urinary tract infections with dapagliflozin. Overall, dapagliflozin may be a better choice for many patients, especially those concerned about weight gain, hypoglycemia, or kidney health 1346+1 MORE.
Sources and full results
Most relevant research papers on this topic
887-P: Renal Benefit of Dapagliflozin Therapy in Hyperfiltering Type 2 Diabetes Patients
Dapagliflozin therapy normalizes glomerular hyperfiltration and reduces renal vascular resistance in hyperfiltering type 2 diabetes patients, but not metformin+glipizide therapy.
Efficacy and safety of dapagliflozin add‐on to evogliptin plus metformin therapy in patients with type 2 diabetes: A randomized, double‐blind, placebo‐controlled study
Dapagliflozin add-on to evogliptin and metformin improved glycemic control and was well tolerated in patients with type 2 diabetes.
Cost of Achieving Combined Improvements in HbA1c and Weight without Hypoglycaemia over 4 Years in a Post-Hoc Analysis of Dapagliflozin + MET Vs Glipizide + MET.
Dapagliflozin + Met is less expensive than glipizide + Met for achieving multiple treatment goals, including weight loss and reducing hypoglycemic events over 4 years.
DOI