Assessment of Insulin Resistance, Oxidative Stress, and Liver Function in Type 2 Diabetic Patients on Dapagliflozin

Abstract Purpose Investigation of the effect of dapagliflozin, on insulin resistance (InRs), glycemic control, oxidative stress (OS), and liver function in patients with type 2 diabetes mellitus (DM) by evaluating the consequence of adding dapagliflozin to metformin. Methods This retrospective cohort study enrolled 117 participants from November 2023 to April 2024. Participants were assigned into three groups. The control group included 48 healthy individuals; the metformin group (DM + MET) included 39 patients, and the metformin and dapagliflozin group (DM + MET + DAPA) included 30 patients. Results The DM + MET + DAPA group had significantly higher serum insulin and InRs than the DM + MET group (p > 0.001 and 0.05 respectively). Dapagliflozin did not disrupt liver function tests. Conversely, A significant decrease in AST levels (p < 0.01) was observed compared to metformin alone. Analysis of OS markers revealed a significant increase in malondialdehyde level and a decrease in total antioxidant capacity (p < 0.01) in dapagliflozin users compared to the DM + MET group. Conclusion Adding dapagliflozin to metformin did not improve insulin sensitivity in type 2 diabetics who are beyond the early stage of the disease, possibly due to deteriorated OS. However, the apparent reduction in AST and neutral effect on other liver function parameters suggests dapagliflozin as an add-on therapy to metformin in diabetic liver diseases. However, routine monitoring of insulin sensitivity is recommended in this patient group.