Effect of dapagliflozin on mineral homeostasis in patients with type 2 diabetes: A real-world retrospective cohort study.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide important glycemic, cardiovascular, and renal benefits in patients with type 2 diabetes mellitus (T2DM). However, their long-term effects on mineral and electrolyte homeostasis in routine clinical practice remain uncertain.
To assess the effects of dapagliflozin on serum calcium, magnesium, phosphorus, creatinine, and parathyroid hormone (PTH) levels in patients with T2DM over two years.
This retrospective cohort study included adults with T2DM treated with dapagliflozin at King Saud University Medical City, Riyadh, Saudi Arabia, between January 2023 and August 2025. Laboratory values were collected at baseline and after one and two years of treatment. Longitudinal changes were evaluated using descriptive statistics, one-way analysis of variance with post-hoc comparisons, and multivariable linear regression.
The study included 549 patients with a mean age of 62.9 ± 12.8 years, and 49.4% were male. Serum calcium increased significantly after one year of dapagliflozin therapy compared with baseline (p = 0.009), with no further significant increase during the second year. Serum magnesium decreased significantly by the second year (p < 0.001). Serum creatinine increased significantly at both follow-up points compared with baseline (p < 0.001). No significant longitudinal changes were observed in serum phosphorus or PTH. In multivariable analysis, the year of measurement independently predicted changes in serum magnesium and phosphorus levels.
Long-term dapagliflozin therapy was associated with statistically significant but clinically modest changes in serum calcium, magnesium, and creatinine, while phosphorus and PTH remained stable over two years. These findings support the overall metabolic safety of dapagliflozin in routine practice. Nevertheless, periodic monitoring of renal function and electrolyte levels, particularly magnesium, may be advisable in patients receiving prolonged therapy or those at increased risk of renal or electrolyte disturbances. Further prospective studies are needed to clarify relevance of these biochemical changes in vulnerable populations.
To assess the effects of dapagliflozin on serum calcium, magnesium, phosphorus, creatinine, and parathyroid hormone (PTH) levels in patients with T2DM over two years.
This retrospective cohort study included adults with T2DM treated with dapagliflozin at King Saud University Medical City, Riyadh, Saudi Arabia, between January 2023 and August 2025. Laboratory values were collected at baseline and after one and two years of treatment. Longitudinal changes were evaluated using descriptive statistics, one-way analysis of variance with post-hoc comparisons, and multivariable linear regression.
The study included 549 patients with a mean age of 62.9 ± 12.8 years, and 49.4% were male. Serum calcium increased significantly after one year of dapagliflozin therapy compared with baseline (p = 0.009), with no further significant increase during the second year. Serum magnesium decreased significantly by the second year (p < 0.001). Serum creatinine increased significantly at both follow-up points compared with baseline (p < 0.001). No significant longitudinal changes were observed in serum phosphorus or PTH. In multivariable analysis, the year of measurement independently predicted changes in serum magnesium and phosphorus levels.
Long-term dapagliflozin therapy was associated with statistically significant but clinically modest changes in serum calcium, magnesium, and creatinine, while phosphorus and PTH remained stable over two years. These findings support the overall metabolic safety of dapagliflozin in routine practice. Nevertheless, periodic monitoring of renal function and electrolyte levels, particularly magnesium, may be advisable in patients receiving prolonged therapy or those at increased risk of renal or electrolyte disturbances. Further prospective studies are needed to clarify relevance of these biochemical changes in vulnerable populations.