​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ 

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This study aims to evaluate the effects and safety of dapagliflozin and empagliflozin on cardiorenal risk factors in T2DM Indonesian patients over a 12-month. Methods This study utilized a multicenter retrospective cohort to evaluate diverse cardiorenal risk factors, encompassing glycemic control, blood pressure, lipid profile, body weight, Body Mass Index (BMI), calculated 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk, and estimated Glomerular Filtration Rate (eGFR), alongside the safety profile of SGLT2is. Paired data analysis, comparative analysis between groups, and linear regression were conducted to adjust the confounding. Results Both groups exhibited enhancements in HbA1c, Fasting Plasma Glucose (FPG), Systolic Blood Pressure (SBP), and Low-Density Lipoprotein Cholesterol (LDL-C). Improvements in BMI, Diastolic Blood Pressure (DBP), triglycerides, ASCVD risk, and High-Density Lipoprotein Cholesterol (HDL-C) were only seen in the dapagliflozin group. The comparative study indicated that dapagliflozin markedly decreased body weight and BMI; however, the results became analogous between groups after correction for confounding variables. No significant differences were observed in the average alteration of HbA1c, FPG, SBP, DBP, LDL-C, HDL-C, triglycerides, total cholesterol, eGFR, and ASCVD risk values. A comparable safety profile was found between groups. Conclusion Dapagliflozin and Empagliflozin provide similar advantages in reducing cardiorenal risk after 12 months of treatment in Indonesian patients with T2DM. 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F1000Research 2025, 14 :569 ( https://doi.org/10.12688/f1000research.163923.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] Fonny Cokro https://orcid.org/0000-0002-9810-1402 1,2 , Rani Sauriasari 1 , Dicky Levenus Tahapary 3,4 , [...] Heri Setiawan 5,6 , Christian Tricaesario https://orcid.org/0000-0003-4771-8389 7,8 , Nurul Hidayati 7 , Sidartawan Soegondo 3,7 Fonny Cokro https://orcid.org/0000-0002-9810-1402 1,2 , Rani Sauriasari 1 , [...] Dicky Levenus Tahapary 3,4 , Heri Setiawan 5,6 , Christian Tricaesario https://orcid.org/0000-0003-4771-8389 7,8 , Nurul Hidayati 7 , Sidartawan Soegondo 3,7 PUBLISHED 09 Jun 2025 Author details Author details 1 Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 2 Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Special Capital Region of Jakarta, 14440, Indonesia 3 Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia 4 Metabolic, Cardiovascular, and Aging Cluster, The Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia 5 Department of Pharmacology, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 6 National Metabolomics Collaborative Research Center, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 7 Diabetes Connection and Care, Eka Hospital BSD, South Tangerang, Indonesia 8 Department of Internal Medicine, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia Fonny Cokro Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation Rani Sauriasari Roles: Conceptualization, Methodology, Resources, Supervision Dicky Levenus Tahapary Roles: Conceptualization, Project Administration, Resources, Supervision Heri Setiawan Roles: Supervision, Writing – Review & Editing Christian Tricaesario Roles: Data Curation, Investigation Nurul Hidayati Roles: Data Curation, Formal Analysis, Investigation Sidartawan Soegondo Roles: Investigation, Resources OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Previous studies compared the cardiorenal efficacy of these two types of SGLT2 inhibitors; however, the findings are inconsistent and do not reflect the population of Type 2 diabetic Mellitus (T2DM) patients in Indonesia, which ranks fifth globally in the number of diabetic patients. This study aims to evaluate the effects and safety of dapagliflozin and empagliflozin on cardiorenal risk factors in T2DM Indonesian patients over a 12-month. Methods This study utilized a multicenter retrospective cohort to evaluate diverse cardiorenal risk factors, encompassing glycemic control, blood pressure, lipid profile, body weight, Body Mass Index (BMI), calculated 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk, and estimated Glomerular Filtration Rate (eGFR), alongside the safety profile of SGLT2is. Paired data analysis, comparative analysis between groups, and linear regression were conducted to adjust the confounding. Results Both groups exhibited enhancements in HbA1c, Fasting Plasma Glucose (FPG), Systolic Blood Pressure (SBP), and Low-Density Lipoprotein Cholesterol (LDL-C). Improvements in BMI, Diastolic Blood Pressure (DBP), triglycerides, ASCVD risk, and High-Density Lipoprotein Cholesterol (HDL-C) were only seen in the dapagliflozin group. The comparative study indicated that dapagliflozin markedly decreased body weight and BMI; however, the results became analogous between groups after correction for confounding variables. No significant differences were observed in the average alteration of HbA1c, FPG, SBP, DBP, LDL-C, HDL-C, triglycerides, total cholesterol, eGFR, and ASCVD risk values. A comparable safety profile was found between groups. Conclusion Dapagliflozin and Empagliflozin provide similar advantages in reducing cardiorenal risk after 12 months of treatment in Indonesian patients with T2DM. READ ALL READ LESS Keywords Cardiovascular diseases, diabetes mellitus, renal insufficiency, retrospective studies, dapagliflozin, empagliflozin Corresponding Author(s) Rani Sauriasari ( [email protected] ) Close Corresponding author: Rani Sauriasari Competing interests: No competing interests were disclosed. Grant information: Indonesia Endowment Fund for Education or Lembaga Pengelola Dana Pendidikan (LPDP), Center for Higher Education Funding and Assessment or Pusat Pelayanan Pembiayaan dan Asesmen Pendidikan Tinggi (PPAPT) and Beasiswa Pendidikan Indonesia (BPI), under the Ministry of Higher Education, Science, and Technology of Republic Indonesia play a role in covering the data collection and publication, through the grant number “00169/BPPT/BPI.06/9/2023”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Cokro F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Cokro F, Sauriasari R, Tahapary DL et al. ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.12688/f1000research.163923.1 ) First published: 09 Jun 2025, 14 :569 ( https://doi.org/10.12688/f1000research.163923.1 ) Latest published: 10 Sep 2025, 14 :569 ( https://doi.org/10.12688/f1000research.163923.3 )  There is a newer version of this article available. Suppress this message for one day. Introduction Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are now currently the first-line treatment endorsed by worldwide and national guidelines for patients with Type 2 Diabetes Mellitus (T2DM) who have heart failure, Atherosclerotic Cardiovascular Disease (ASCVD), a high-risk of ASCVD, and Chronic Kidney Disease (CKD). 1 – 4 Apart from that, SGLT2is are also recommended for T2DM patients who are prone to hypoglycemia and are overweight or obese. 5 At present, the SGLT2is available in Indonesia are dapagliflozin and empagliflozin, which were launched in 2016 and 2017, respectively. 6 – 9 Numerous prior extensive retrospective cohort studies have compared the efficacy of empagliflozin and dapagliflozin regarding cardiovascular occurrences, although the findings are inconsistent. 10 – 12 These studies do not adequately represent the T2DM population in Southeast Asia, especially in Indonesia, which has the fifth-greatest number of T2DM patients globally. 13 Diabetes elevates the risk of CKD, coronary artery disease, and heart failure. Cardiorenal complications elevate the risk of mortality, hospital readmission, and deteriorate health-related quality of life. 14 – 16 Consequently, efficient pharmaceutical approaches to achieve glycemic control and safeguard against cardiorenal complications are essential for patients with diabetes mellitus. Therefore, it is necessary to investigate the actual context of regular clinical practice in Indonesia, acknowledging potential differences in genetics, socioeconomic status, lifestyle, and healthcare systems that may affect cardiorenal outcomes. 17 – 20 A meta-analysis examining the impact of race or ethnicity on cardiovascular outcomes from antidiabetic treatments indicates that varying racial or ethnic backgrounds may result in disparate outcomes. 21 A retrospective cohort study in the United Kingdom showed that white, black, and Asian ethnicities had different glycemic control. Asian patients with T2DM exhibit lower levels of obesity and greater insulin sensitivity compared to Caucasians, 22 which may influence cardiorenal outcomes. Thus, this study seeks to address the gap by comparing the effects and safety of dapagliflozin and empagliflozin on cardiorenal risk factors in T2DM Indonesian patients over a 12-month treatment period. The findings will provide valuable insights into these agents’ real-world effectiveness and safety profiles, guiding personalized diabetes management in Indonesia. Methods Study design, setting and data sources This research utilized a retrospective cohort. Data gathered from July 2024 to December 2024 came from Rumah Sakit Cipto Mangunkusumo (RSCM) Kencana, SS Diabetes Care, and Diabetes Connection Care (DCC) Eka Hospital in Jakarta and its surroundings. All samples were followed up until the end of therapy, transferred to another health facility, or until the end of data collection to evaluate the effectiveness and safety of SGLT2is. Study participants T2DM individuals aged 18 years or older were eligible for participation, as shown by previous medical records or ICD-10 categorization. The sample size calculation was conducted using G*Power software, which determined that a minimum of 210 participants was required for a t-test analysis, based on the assumption of two independent groups, a medium effect size (d = 0.50), a two-tailed distribution, a statistical power of 0.95, and an equal allocation ratio of 1:1. Exposure Participants were categorized into two groups: those receiving dapagliflozin, and those treated with empagliflozin, as monotherapy or combination therapy. Only patients with at least 12 months of SGLT2i use were included to mitigate potential confounding factors. This threshold was based on meta-analysis findings indicating that significant reductions in urine albumin-to-creatinine ratio (UACR) can be observed within 26 to 52 weeks of treatment, 23 allowing sufficient time for renal protective effects. Patients with incomplete primary outcome data or inconsistent measurements over 24 months were excluded to minimize bias resulting from non-compliance with therapy adherence. Variables The primary outcome assessed was the change in HbA1c from baseline, serving as an indicator of glycemic control. Secondary outcomes included changes in atherosclerotic cardiovascular disease (ASCVD) risk, assessed via the revised Pooled Cohort Equations (RPCE) calculator 24 ; fasting plasma glucose (FPG); systolic blood pressure (SBP); diastolic blood pressure (DBP); weight; body mass index (BMI); estimated glomerular filtration rate (eGFR); lipid profile; and incidence of adverse drug reactions. Common side effects analyzed included urinary tract infections (UTIs) and genital infections, while severe adverse events such as hypoglycemia, diabetic ketoacidosis, bone fractures, and lower extremity amputations 25 , 26 were also recorded. Hypoglycemia was defined as random blood glucose levels under 70 mg/dL, 1 , 27 while UTIs were confirmed via urine or culture tests or documented physician diagnosis. Diabetic ketoacidosis was identified based on ketone presence in blood tests or physician assessment. Potential confounding factors included age, sex, smoking status, diabetes duration, number of concurrent diabetes medications, and comorbidities such as hypertension, dyslipidemia, cardiovascular disease history, microvascular complications, and adverse drug effects. 28 – 30 Confounding data were retrospectively extracted from medical records and incorporated into baseline analyses. Missing lipid profile data were imputed using the Sampson-NIH formula, while eGFR was estimated using the CKD-EPI equation. Missing secondary data were handled using linear interpolation for absent baseline values, linear extrapolation for missing intermediate or final data, and mean imputation for non-patterned data. Analysis The Kolmogorov-Smirnov test was used to assess the normality of continuous variables. Parametric data were analyzed using the t-test, while the Mann-Whitney U test was applied for non-parametric variables. The chi-square test was employed to evaluate categorical safety outcomes. A multivariate linear regression model accounted for potential confounders to adjust for baseline differences. Sensitivity analysis was performed by excluding cases with missing data. All statistical analyses were set to have a significance level of p ≤ 0.05 and conducted using SPSS Base Version 22 software. Results A total of 502 eligible patient records were collected from three data-collecting sites, resulting in the inclusion of 319 patients following the screening process, with 154 and 165 patients incorporated and evaluated in the dapagliflozin and empagliflozin groups, respectively, as seen in Figure 1 . The baseline demographics exhibited similarities between the groups, except age (55 years in the dapagliflozin group versus 58 years in the empagliflozin group), history of sulfonylurea usage (62 patients in the dapagliflozin group versus 93 patients in the empagliflozin group), history of thiazolidinedione usage (23 patients in the dapagliflozin group versus seven patients in the empagliflozin group), history of acarbose usage (5 patients in the dapagliflozin group versus zero patients in the empagliflozin group), history of beta-blocker usage (10 patients in the dapagliflozin group versus 30 patients in the empagliflozin group), weight (80.7 kg in the dapagliflozin group versus 74.175 kg in the empagliflozin group), and eGFR (90.560 mL/min/1.73 m 2 in the dapagliflozin group versus 81.667 mL/min/1.73 m 2 in the empagliflozin group), as seen in Table 1 . The average duration of SGLT2is use observed in this study was 14.18 months. Figure 1. Flowchart of samples. The study was initiated with a screening of 502 patients, and a total of 319 patients were analyzed. The dapagliflozin group consisted of 154 patients, while the empagliflozin group consisted of 165 patients. Table 1. The baseline demographic of the included samples. Components Dapagliflozin (N = 154) Empagliflozin (N = 165) p-value Age (years) 55.06 ± 9.940 58.12 ±11.332 0.005 Gender (male) 91 (59.091%) 98 (59.394%) 0.956 Smoking history 10 (6.493%) 12 (7.273%) 0.784 Diabetes duration (years) 3 (2-4) 4 (2-5) 0.243 Number of diabetes medications 3 (2-4) 3 (2-4) 0.314 Medication history: Metformin 131 (85.065%) 127 (76.970%) 0.066 Sulfonylurea 62 (40.260%) 93 (56.364%) 0.004 DPP-4 inhibitor 119 (77.273%) 121 (73.333%) 0.415 GLP-1 agonist 15 (9.740%) 22 (13.333%) 0.317 Metiglinide 0 (0%) 0 (0%) - Thiazolidindione 23 (14.935%) 7 (4.242%) 0.001 Acarbose 5 (3.247%) 0 (0%) 0.020 Insulin 40 (25.974%) 36 (21.818%) 0.384 ACE inhibitor/ARB 63 (40.909%) 59 (35.758%) 0.344 Beta-blocker 10 (6.494%) 30 (18.182%) 0.002 Aldosterone antagonist 0 (0%) 1 (0.606%) 1.000 Statin 125 (81.169%) 135 (81.812% 0.881 Aspirin 27 (17.532%) 20 (12.121%) 0.173 History of illness: Coronary Artery Disease 20 (12.987%) 28 (16.970%) 0.320 Stroke 9 (5.844%) 8 (4.848%) 0.692 Peripheral Artery Disease 6 (3.896%) 6 (3.636%) 0.903 Hypertension 96 (62.338%) 88 (53.333%) 0.104 Dyslipidemia 132 (85.714%) 145 (87.879%) 0.568 Heart failure 3 (1.948%) 4 (2.424%) 0.772 Diabetic nephropathy 30 (19.481%) 27 (16.364%) 0.468 Diabetic neuropathy 12 (7.792%) 16 (9.670%) 0.548 Diabetic retinopathy 5 (3.247%) 7 (4.242%) 0.640 Hypoglycemia 1 (0.649%) 0 (0%) 0.300 HbA1c (%) 8.762 ± 1.776 8.865 ± 1.849 0.612 HbA1c (≤7%) 7 (4.545%) 20 (12.121%) 0.568 Weight (kg) 80.700 ± 15.724 74.175 ± 14.447 0.000 Body Mass Index 29.030 ± 5.639 28.036 ± 4.490 0.054 Fasting Plasma Glucose (mg/dL) 166.182 ± 50.841 165.500 ± 57.081 0.931 Systolic Blood Pressure (mmHg) 133.450 ± 15.806 132.92 ± 17.793 0.801 Diastolic Blood Pressure (mmHg) 78.86 ± 8.260 77.48 ± 9.274 0.130 Low-density lipoprotein Cholesterol (mg/dL) 112.199 ± 42.951 111.156 ± 41.284 0.835 High-density lipoprotein Cholesterol (mg/dL) 43.498 ± 11.756 43.236 ± 10.743 0.622 Triglyceride (mg/dL) 184.048 ± 287.157 180.840 ± 167.420 0.911 Total cholesterol (mg/dL) 193.526 ± 46.950 188.363 ± 55.153 0.437 Estimated Glomerular Filtration Rate (mL/min/1.73 m 2 ) 90.560 ± 26.430 81.667 ± 26.502 0.004 ASCVD Risk (%) 13.526 ± 11.736 13.912 ± 12.703 0.827 Data presented as means (SD), numbers (%), or medians (IQR range) for ordinal data types. DPP-4 inhibitor = Dipeptidyl peptidase-4 inhibitor; GLP-1 agonist = Glucagon-like Peptide-1 Agonist; ACE inhibitor = Angiotensin-Converting Enzyme inhibitor; ARB = Angiotensin Receptor Blocker; ASCVD risk = Atherosclerotic Cardiovascular Disease risk. Paired data analysis of dapagliflozin and empagliflozin demonstrated a significant reduction in HbA1c (-1.121% vs. -0.986%), FPG (-29.531 mg/dL vs. -25.238 mg/dL), SBP (-8.382 mmHg vs. -4.341 mmHg), and LDL-C (-12.212 mg/dL vs. -17 mg/dL) after 12 months of administration. Nonetheless, substantial decreases in weight, BMI, DBP, triglycerides, ASCVD risk, and a rise in HDL-C were observed exclusively in the dapagliflozin group. Empagliflozin markedly decreased total cholesterol by -16.586 mg/dL. Both groups had a reduction in eGFR at 12 months, which is -0.927 mL/min/1.73 m 2 in the dapagliflozin group and -2.169 mL/min/1.73 m 2 in the empagliflozin group, as illustrated in Table 2 . Both groups had similar patterns in enhancing glycemic control, blood pressure, lipid profile, and ASCVD risk, alongside a reduction in eGFR. Table 2. Effectiveness paired data analysis of Dapagliflozin and Empagliflozin. Components n SGLT2is Means ± SD at baseline Means ± SD after 12 months p-value Dapagliflozin HbA1c (%) 154 8.762 ± 1.776 7.641 ± 1.189 0.000 Weight (kg) 109 80.879 ± 16.159 78.568 ± 15.186 0.000 BMI 86 29.286 ± 4.831 28.584 ± 4.751 0.000 FPG (mg/dL) 103 164.200 ± 48.210 134.669 ± 38.776 0.000 SBP (mmHg) 109 133.360 ± 16.142 124.978 ± 13.374 0.000 DBP (mmHg) 108 79.030 ± 8.278 76.482 ± 9.689 0.009 LDL-C (mg/dL) 115 112.898 ± 44.024 100.686 ± 32.177 0.042 HDL-C (mg/dL) 85 43.901 ± 11.642 45.303 ± 10.906 0.024 Triglyceride (mg/dL) 92 187.570 ± 318.043 146.901 ± 80.995 0.019 Total Cholesterol (mg/dL) 85 192.114 ± 46.305 177.019 ± 42.454 0.133 eGFR (mL/min/1.73 m 2 ) 97 88.352 ± 26.109 84.819 ± 26.465 0.000 ASCVD Risk (%) 72 12.833 ± 11.657 11.906 ± 12.498 0.044 Empagliflozin HbA1c (%) 165 8.865 ± 1.849 7.879 ± 1.474 0.000 Weight (kg) 117 74.479 ± 14.665 73.604 ± 14.933 0.118 BMI 103 28.264 ± 4.570 27.948 ± 4.764 0.183 FPG (mg/dL) 136 164.188 ± 55.239 138.950 ± 37.464 0.000 SBP (mmHg) 111 134.100 ± 18.676 129.759 ± 15.514 0.013 DBP (mmHg) 111 77.580 ± 9.696 75.938 ± 10.640 0.187 LDL-C (mg/dL) 143 110.301 ± 40.459 93.301 ± 36.438 0.000 HDL-C (mg/dL) 114 42.973 ± 10.886 43.947 ± 10.999 0.185 Triglyceride (mg/dL) 128 184.367 ± 176.046 168.358 ± 125.796 0.236 Total Cholesterol (mg/dL) 117 187.422 ± 54.937 170.836 ± 46.377 0.005 eGFR (mL/min/1.73 m 2 ) 128 81.063 ± 26.595 78.894 ± 26.706 0.015 ASCVD Risk (%) 81 13.241 ± 12.911 11.388 ± 9.523 0.087 The comparative analysis of effectiveness revealed that dapagliflozin significantly reduced body weight (-2.311 ± 5.173 kg vs. -0.875 ± 4.954) and BMI (-0.702 ± 1.863 vs. -0.316 ± 1.919) compared with empagliflozin. Due to a substantial disparity in baseline weight between the two groups, a supplementary analysis was conducted utilizing the percentage of weight difference, calculated as the difference between initial and final weight divided by the baseline weight, subsequently expressed as a percentage to normalize the baseline discrepancy, yielding robust results that favor dapagliflozin (-2.566% ± 5.863 vs. -1.080% ± 6.493; p = 0.001). No significant changes were seen in the mean values of HbA1c, FPG, SBP, DBP, LDL-C, HDL-C, triglycerides, total cholesterol, eGFR, and ASCVD risk (p>0.05), as seen in Table 3 . Additional analysis to overcome the eGFR difference between the two groups by utilizing the percentage of eGFR difference shows robust results (-3.410 ± 15.343 vs. -2.526 ± 17.913; p = 0.698), meaning no difference between the two groups. The sensitivity analysis, by excluding missing data, yielded a robust conclusion for each comparison. However, the multivariate linear regression results indicated that differences in sulfonylurea use history and baseline body weight between groups influenced the body weight and BMI parameters. The adjusted outcomes for confounding indicated a weight reduction of -1.969 kg in the dapagliflozin group compared to -1.233 kg in the empagliflozin group; p = 0.282 for body weight parameter, and -0.616 in the dapagliflozin group versus -0.367 in the empagliflozin group; p = 0.467. Table 3. Effectiveness comparative analysis of Dapagliflozin vs. Empagliflozin. Components Means ± SD Dapagliflozin Means ± SD Empagliflozin p-value N Dapagliflozin N Empagliflozin HbA1c Difference (%) -1.121 ± 1.707 -0.987 ± 1.688 0.482 154 165 Weight Difference (kg) -2.311 ± 5.173 -0.875 ± 4.954 0.000 109 117 BMI Difference -0.702 ± 1.863 -0.316 ± 1.919 0.008 86 103 FPG Difference (mg/dL) -29.531 ± 53.289 -25.238 ± 62.411 0.576 103 136 SBP Difference (mmHg) -8.380 ± 15.628 -4.340 ± 17.430 0.117 109 111 DBP Difference (mmHg) -2.546 ± 9.865 -1.638 ± 11.110 0.524 108 111 LDL-C Difference (mg/dL) -10.779 ± 50.930 0.974 ± 7.809 0.064 116 114 HDL-C Difference (mg/dL) 1.401 ± 10.113 0.974 ± 7.809 0.737 85 114 Triglyceride Difference (mg/dL) -40.669 ± 280.948 -16.009 ± 165.208 0.415 92 128 Total Cholesterol Difference (mg/dL) -15.094 ± 56.678 -16.590 ± 62.108 0.861 86 117 eGFR Difference (mL/min/1.73 m 2 ) -3.533 ± 12.191 -2.791 ± 13.240 0.667 97 128 ASCVD Risk Difference (%) -0.928 ± 5.409 -1.853 ± 8.212 0.418 72 81 The safety study of both groups revealed no significant differences in any adverse event components, including genital infections, UTI, hypoglycemia, diabetic ketoacidosis, fractures, lower extremity amputations, and overall adverse events (p > 0.05). These results are illustrated in Table 4 . Table 4. Safety comparison of Dapagliflozin vs. Empagliflozin. Safety components n Dapagliflozin n Empagliflozin N Dapagliflozin N Empagliflozin p-value Genital infections 0 0 154 165 Urinary tract infections 4 5 154 165 1.000 Hypoglycemia 0 1 154 165 1.000 Diabetic ketoacidosis 0 0 154 165 Fractures 1 1 154 165 1.000 Lower extremities amputation 0 0 154 165 Any adverse events 5 7 154 165 0.640 Discussion According to paired data analysis, dapagliflozin and empagliflozin have comparable efficacy in enhancing glycemic control, specifically for reducing HbA1c and FPG levels. This aligns with the findings of a prior retrospective study including T2DM patients, which demonstrated a reduction in HbA1c in both groups after an average follow-up period of 24.5 months. 31 Nonetheless, a separate retrospective trial involving diabetic individuals with a history of chronic kidney disease indicated that dapagliflozin 10 mg was more effective than empagliflozin in reducing HbA1c, at both 10 mg and 25 mg dosages. 32 The results of this trial indicate similar efficacy between groups in reducing body weight and BMI; even though before controlling for differences in sulfonylurea history and baseline body weight, the findings favor dapagliflozin. Sulfonylureas augment the visceral fat compartment, resulting in increased body weight 33 and biased the body weight outcome. A prior meta-analysis demonstrated a similar result, showing comparable effects between dapagliflozin and empagliflozin on weight gain. 34 An extensive retrospective cohort research in Taiwan showed that dapagliflozin resulted in a 31% reduction in LDL-C compared to empagliflozin, particularly in patients with baseline LDL levels below 100 mg/dL. 11 The superior reduction in LDL-C within the dapagliflozin group may positively influence the prevention of cardiovascular events. A substantial retrospective cohort research conducted in Korea demonstrated that dapagliflozin administration in patients with T2DM decreased 24% the incidence of cardiovascular mortality and 16% hospitalization resulting from heart failure. 12 The findings of the Korean study contradict those of another extensive retrospective cohort trial, which demonstrated empagliflozin’s superiority for both outcomes. 10 The disparity is likely due to the later study’s patients having a history of heart failure and being predominantly Caucasian, with only 4.6% identifying as Asian. 10 Consequently, dapagliflozin may be more effective in mitigating the risk of heart failure among Asians. The resemblance of ASCVD risk values between the two groups is attributable to the similar risk assessment components in this study, which include comparable SBP, HDL-C, and total cholesterol values. 35 The congruence of SBP values is corroborated by prior meta-analyses, indicating no significant difference between dapagliflozin 10 mg and empagliflozin at both 10 mg and 25 mg dosages. 34 A prior retrospective cohort study examining kidney function in individuals with T2DM and CKD stages G1-G4 over an 18-month follow-up revealed that the dapagliflozin 10 mg group exhibited a superior increase in eGFR compared to the empagliflozin dosages of 10 and 25 mg. 32 A separate retrospective investigation indicated an elevation in eGFR after an average usage length of 23.7 months, based on paired data analysis results, in both the dapagliflozin and empagliflozin groups. 31 However, the findings of the prior study contrast with those of the current study, likely attributable to the shorter follow-up period in the latter. Furthermore, the patient features in the present investigation diverge from those in the prior comparative analysis, which exclusively included patients with a history of CKD. The findings of this investigation indicated comparable safety between the two groups. A retrospective cohort conducted in Turkey demonstrated analogous findings, particularly with the frequency of urinary tract infections and genital infections. 31 Furthermore, the utilization of SGLT2is is regarded as safe, presenting a limited risk of adverse events; however, with the increasing risk of genital infections, including in Asian. 36 – 39 Adverse effects in the current study may remain unrecorded concerning the documentation of safety components. Thus, further evaluation is highly recommended. This study has the advantage of including patients from various levels of healthcare facilities, from primary to tertiary levels. Nonetheless, multiple limitations exist in the study; primarily, it is a retrospective analysis characterized by missing data. In this case, researchers have implemented multiple data imputation techniques and conducted sensitivity analyses, which yielded robust outcomes. The second constraint is the significant difference between the two groups in some of the baseline characteristics; however, the adjustment has been made to the affected result. The third constraint is the potential for non-compliance, which may impact the outcomes. Last but not least, this study was conducted exclusively in an Indonesian population, which may limit the generalisability of the findings to populations in other geographic regions. Cultural factors, genetic backgrounds, disease epidemiology, and treatment access may differ in other countries. However, the observed associations may still be relevant to similar settings in Southeast Asia or other low- and middle-income countries with comparable patient profiles and healthcare infrastructures. Conclusion Dapagliflozin and Empagliflozin yield comparable benefits on cardiorenal risk mitigation after 12 months of administration in Indonesian patients with T2DM. Longer-duration, larger-scale studies are needed to confirm the results of this study. Ethical considerations and consent Before the commencement of the investigation, the research design underwent evaluation by the Investigation Ethics Committee of RSCM (KET-749/UN2.F1/ETIK/PPM.00.02/2024) dated September 26, 2024; and the Atma Jaya Catholic University of Indonesia (01/05/KEP-FKIKUAJ/2024) dated May 7, 2024. There is no necessity for informed assent in this study, as it is retrospective. 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Reference Source Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 2 Department of Pharmacy, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Special Capital Region of Jakarta, 14440, Indonesia 3 Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia 4 Metabolic, Cardiovascular, and Aging Cluster, The Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia 5 Department of Pharmacology, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 6 National Metabolomics Collaborative Research Center, Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia 7 Diabetes Connection and Care, Eka Hospital BSD, South Tangerang, Indonesia 8 Department of Internal Medicine, Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia Fonny Cokro Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation Rani Sauriasari Roles: Conceptualization, Methodology, Resources, Supervision Dicky Levenus Tahapary Roles: Conceptualization, Project Administration, Resources, Supervision Heri Setiawan Roles: Supervision, Writing – Review & Editing Christian Tricaesario Roles: Data Curation, Investigation Nurul Hidayati Roles: Data Curation, Formal Analysis, Investigation Sidartawan Soegondo Roles: Investigation, Resources Competing interests No competing interests were disclosed. Grant information Indonesia Endowment Fund for Education or Lembaga Pengelola Dana Pendidikan (LPDP), Center for Higher Education Funding and Assessment or Pusat Pelayanan Pembiayaan dan Asesmen Pendidikan Tinggi (PPAPT) and Beasiswa Pendidikan Indonesia (BPI), under the Ministry of Higher Education, Science, and Technology of Republic Indonesia play a role in covering the data collection and publication, through the grant number “00169/BPPT/BPI.06/9/2023”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 10 Sep 2025, 14:569 https://doi.org/10.12688/f1000research.163923.3 version 2 Revised Published: 19 Aug 2025, 14:569 https://doi.org/10.12688/f1000research.163923.2 version 1 Published: 09 Jun 2025, 14:569 https://doi.org/10.12688/f1000research.163923.1 Copyright © 2025 Cokro F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Cokro F, Sauriasari R, Tahapary DL et al. ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.12688/f1000research.163923.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Jun 2025 Views 0 Cite How to cite this report: HODA F. Reviewer Report For: ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.5256/f1000research.180344.r401370 ) The direct URL for this report is: https://f1000research.com/articles/14-569/v1#referee-response-401370 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Aug 2025 FARAZUL HODA , Jamia Hamdard University, New Delhi, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180344.r401370 Research have been presented well but few of the comments from my end that will help authors to be present for fulfilment of the research presented. 1. Conclusion can be more elaborated write about the main findings and conclude ... Continue reading READ ALL Research have been presented well but few of the comments from my end that will help authors to be present for fulfilment of the research presented. 1. Conclusion can be more elaborated write about the main findings and conclude appropriately. 2. Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. 3. Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Diabetes and Diabetic Kidney Disease I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT HODA F. Reviewer Report For: ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.5256/f1000research.180344.r401370 ) The direct URL for this report is: https://f1000research.com/articles/14-569/v1#referee-response-401370 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Sep 2025 Fonny Cokro , Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia 05 Sep 2025 Author Response Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your ... Continue reading Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your expectations. Our summary response is as follows: Recommendation: Conclusion can be more elaborated write about the main findings and conclude appropriately. Response: Thank you for your valuable feedback. We have revised the conclusion to meet your recommendations, which elaborates more about the findings. Recommendation: Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. Response: Thank you for your valuable feedback. We have added explanations about how data were collected and extracted in “Study Design and Data Sources”. We had provided information about missing data handling in the “Variables” section. Recommendation: Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Response: Thank you for your valuable feedback. We have revised the flow diagram to meet your recommendations, as follows: 1) We missed the arrow from the number of inclusion to the number of analyzed patients, thus we added the arrow; 2) We added the number of exclusions based on the reasoning to provide a better description; 3) We changed the diagram to make it more symmetrical and have a better presentation. Best regards, Authors Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your expectations. Our summary response is as follows: Recommendation: Conclusion can be more elaborated write about the main findings and conclude appropriately. Response: Thank you for your valuable feedback. We have revised the conclusion to meet your recommendations, which elaborates more about the findings. Recommendation: Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. Response: Thank you for your valuable feedback. We have added explanations about how data were collected and extracted in “Study Design and Data Sources”. We had provided information about missing data handling in the “Variables” section. Recommendation: Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Response: Thank you for your valuable feedback. We have revised the flow diagram to meet your recommendations, as follows: 1) We missed the arrow from the number of inclusion to the number of analyzed patients, thus we added the arrow; 2) We added the number of exclusions based on the reasoning to provide a better description; 3) We changed the diagram to make it more symmetrical and have a better presentation. Best regards, Authors Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Sep 2025 Fonny Cokro , Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia 05 Sep 2025 Author Response Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your ... Continue reading Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your expectations. Our summary response is as follows: Recommendation: Conclusion can be more elaborated write about the main findings and conclude appropriately. Response: Thank you for your valuable feedback. We have revised the conclusion to meet your recommendations, which elaborates more about the findings. Recommendation: Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. Response: Thank you for your valuable feedback. We have added explanations about how data were collected and extracted in “Study Design and Data Sources”. We had provided information about missing data handling in the “Variables” section. Recommendation: Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Response: Thank you for your valuable feedback. We have revised the flow diagram to meet your recommendations, as follows: 1) We missed the arrow from the number of inclusion to the number of analyzed patients, thus we added the arrow; 2) We added the number of exclusions based on the reasoning to provide a better description; 3) We changed the diagram to make it more symmetrical and have a better presentation. Best regards, Authors Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your expectations. Our summary response is as follows: Recommendation: Conclusion can be more elaborated write about the main findings and conclude appropriately. Response: Thank you for your valuable feedback. We have revised the conclusion to meet your recommendations, which elaborates more about the findings. Recommendation: Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. Response: Thank you for your valuable feedback. We have added explanations about how data were collected and extracted in “Study Design and Data Sources”. We had provided information about missing data handling in the “Variables” section. Recommendation: Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Response: Thank you for your valuable feedback. We have revised the flow diagram to meet your recommendations, as follows: 1) We missed the arrow from the number of inclusion to the number of analyzed patients, thus we added the arrow; 2) We added the number of exclusions based on the reasoning to provide a better description; 3) We changed the diagram to make it more symmetrical and have a better presentation. Best regards, Authors Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 09 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 10 Sep 25 read Version 2 (revision) 19 Aug 25 read Version 1 09 Jun 25 read FARAZUL HODA , Jamia Hamdard University, New Delhi, India Aimen Shafiq , Dow University of Health Sciences, Karachi, Pakistan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 HODA F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Sep 2025 | for Version 3 FARAZUL HODA , Jamia Hamdard University, New Delhi, India 0 Views copyright © 2025 HODA F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions After revision, this article can be accepted. Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes and Diabetic Kidney Disease I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) HODA F. Peer Review Report For: ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.5256/f1000research.187854.r413133) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-569/v3#referee-response-413133 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Shafiq A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2025 | for Version 2 Aimen Shafiq , Dow University of Health Sciences, Karachi, Pakistan 0 Views copyright © 2025 Shafiq A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This retrospective cohort study compares the effectiveness and safety of dapagliflozin and empagliflozin over 12 months in Indonesian patients with Type 2 Diabetes Mellitus. Both drugs showed similar improvements in cardiorenal risk factors, with dapagliflozin offering slight advantages in weight and BMI reduction, though these were not significant after adjusting for confounders. Safety profiles were comparable. My Comments: 1) Grammar and awkward phrasing occur frequently, which affect the readability: Example: “...which ranks fifth globally in the number of diabetic patients.” This could be rephrased as "Indonesia, which ranks fifth globally in diabetes prevalence." “The comparative study indicated that dapagliflozin markedly decreased body weight and BMI; however, the results became analogous between groups...” Consider: "Although dapagliflozin was associated with greater reductions in weight and BMI, these differences were not statistically significant after adjustment." 2) Inconsistent terminology: Use of “SGLT2is” vs. “SGLT2 inhibitors” vs. “SGLT2i” should be standardized. 3) It’s unclear whether patients were randomly selected or if clinician discretion influenced who received dapagliflozin vs. empagliflozin. This may introduce treatment allocation bias. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Shafiq A, Hameed I, Biegus J, Fudim M, et al.: Empagliflozin in the treatment of heart failure. Future Cardiology . 2024; 20 (5-6): 251-261 Publisher Full Text 2. Shafiq A, Mahboob E, Samad M, Ur Rehman M, et al.: The dual role of empagliflozin: Cardio renal protection in T2DM patients. Annals of Medicine & Surgery . 2022; 81 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Cardiovascular I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 11 Sep 2025 Fonny Cokro, Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia Dear Dr. Aimen Shafiq, Thank you very much for your feedback. 1) We have revised the sentences accordingly. 2) We have revised the sentences accordingly. 3) Patients were not randomized in this retrospective cohort study; however, all patients with a history of using dapagliflozin or empagliflozin for at least 12 months were selected, as outlined in the Methods section. Best regards, Authors View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Shafiq A. Peer Review Report For: ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.5256/f1000research.186699.r407992) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-569/v2#referee-response-407992 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 HODA F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Aug 2025 | for Version 1 FARAZUL HODA , Jamia Hamdard University, New Delhi, India 0 Views copyright © 2025 HODA F. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Research have been presented well but few of the comments from my end that will help authors to be present for fulfilment of the research presented. 1. Conclusion can be more elaborated write about the main findings and conclude appropriately. 2. Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. 3. Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes and Diabetic Kidney Disease I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 05 Sep 2025 Fonny Cokro, Department of Clinical and Social Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia Dear Dr. Farazul Hoda, Your feedback is greatly appreciated. We have made the following revisions to this article in response to your feedback. We hope our revisions meet your expectations. Our summary response is as follows: Recommendation: Conclusion can be more elaborated write about the main findings and conclude appropriately. Response: Thank you for your valuable feedback. We have revised the conclusion to meet your recommendations, which elaborates more about the findings. Recommendation: Method section can be more elaborated in study design and data sources. Explain about how data were collected and extracted, how they have screen the data, if any data in sheet is missing how they have handled. Response: Thank you for your valuable feedback. We have added explanations about how data were collected and extracted in “Study Design and Data Sources”. We had provided information about missing data handling in the “Variables” section. Recommendation: Better to add a follow diagram of participants selection and divide it into two groups for better presentation. Response: Thank you for your valuable feedback. We have revised the flow diagram to meet your recommendations, as follows: 1) We missed the arrow from the number of inclusion to the number of analyzed patients, thus we added the arrow; 2) We added the number of exclusions based on the reasoning to provide a better description; 3) We changed the diagram to make it more symmetrical and have a better presentation. Best regards, Authors View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern HODA F. Peer Review Report For: ​​Dapagliflozin vs. Empagliflozin for cardiorenal risk reduction: Real-world paired data and comparative study in Indonesia​ [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :569 ( https://doi.org/10.5256/f1000research.180344.r401370) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-569/v1#referee-response-401370 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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