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SGLT inhibitor adjunct therapy in type 1 diabetes
Rory J McCrimmon1, Robert R Henry2
1School of Medicine, Mail Box 12, Level 7 University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK. r.mccrimmon@dundee.ac.uk.
Diabetologia
|August 23, 2018
Summary
Sodium-glucose cotransporter (SGLT) inhibitors show promise as an adjunct therapy for type 1 diabetes, improving glycemic control and reducing insulin doses. However, increased risks of diabetic ketoacidosis and infections require further study.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Non-insulin adjunct therapies are explored for type 1 diabetes to enhance glycemic control and mitigate hypoglycemia.
- Limited evidence and few effective pharmacological agents currently exist for routine clinical use.
Purpose of the Study:
- To evaluate the efficacy and safety of sodium-glucose cotransporter (SGLT) inhibitors as an adjunct therapy in type 1 diabetes management.
Main Methods:
- Analysis of two international, multicentre, randomized, controlled Phase II and Phase III clinical trials (DEPICT-1 and inTandem3).
- Investigated the effects of dapagliflozin and sotagliflozin on glycemic control, insulin dosage, and adverse events.
Main Results:
- SGLT inhibition resulted in a 5-6 mmol/mol (0.4-0.5%) reduction in HbA1c, alongside weight loss and decreased daily insulin doses.
- No significant increase in hypoglycemia risk was observed, but a higher incidence of diabetic ketoacidosis and mycotic infections occurred.
Conclusions:
- SGLT inhibitors demonstrate potential as a valuable adjunct therapy for type 1 diabetes.
- Longer-term studies and observational data are necessary to confirm benefits, assess long-term risks, and identify optimal patient populations.
- Patient and healthcare professional education is crucial for safe implementation in clinical practice.
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