Acute renoprotective effects of dapagliflozin monotherapy on albuminuria and metabolic derangements in newly diagnosed type 2 diabetes mellitus: a quasi-experimental study

Diabetic kidney disease (DKD) is a globally prominent microvascular sequela of Type 2 Diabetes Mellitus (T2DM), making effective early prevention paramount. The well-established cardiorenal benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2i) are largely derived from studies on patients with T2DM. Clear evidence is lacking to support the use of SGLT2i as a first-line monotherapy in newly diagnosed T2DM patients who have not yet initiated other glucose-lowering or protective agents. This study aimed to fill this knowledge gap by assessing the acute impact of Dapagliflozin on reducing albuminuria and correcting metabolic derangements during this critical early disease window to halt disease progression at its onset. This quasi-experimental study conducted over a 3-month intervention period, included 133 newly diagnosed T2DM patients (76 males, 57 females) with evidence of micro- or macro-albuminuria. All patients were treated with Dapagliflozin 10 mg/day, primary and secondary endpoints were assessed by cardiorenal markers (albumin-to creatinine ratio (ACR) and calculated glomerular filtration rate (GFR)), metabolic marker (HbA1c), Anthropometric parameters (BMI and blood pressure), were measured at baseline and follow-up, Paired t-tests were used for pre- and post-intervention analysis. Dapagliflozin significantly improved both metabolic and renal markers within the short follow-up period. The primary outcome, ACR, declined markedly from 108.44 mg/g to 65.79 mg/g (P < 0.001), representing a mean relative reduction of approximately 40%. Glycemic control was rapidly achieved, with a mean HbA1c drop from 9.04% to 7.31% (P < 0.001). While calculated GFR remained stable overall, a significant reduction in systolic blood pressure was also observed (P < 0.001). Dapagliflozin demonstrates a rapid and multi-organ protective effect when introduced early in T2DM, achieving potent reduction in albuminuria and excellent glycemic control while preserving kidney function stability. These findings strongly support the integration of SGLT2i as a first-line therapy to mitigate cardiorenal risk from the earliest stages of T2DM.