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Empagliflozin in type 1 diabetes.

Chantal Mathieu1, Laura Van Den Mooter1, Bert Eeckhout1

  • 1Endocrinology, UZ Gasthuisberg, Leuven 3000, Belgium.

Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy
|November 6, 2019
PubMed
Summary

Empagliflozin, a sodium-glucose cotransporter type 2 inhibitor, shows benefits for type 1 diabetes (T1D) patients by improving HbA1c and weight. While generally safe, careful monitoring for diabetic ketoacidosis (DKA) is crucial.

Keywords:
EASE trialsSGLT2 inhibitorempagliflozintype 1 diabetes

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Type 1 diabetes (T1D) management faces challenges including hypoglycemia, weight gain, and glucose variability.
  • Existing treatments improve quality of life but do not fully address these persistent issues.

Purpose of the Study:

  • To review the clinical efficacy and safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, as an adjunct therapy in T1D.
  • To evaluate the impact of empagliflozin on glycemic control, body weight, and insulin requirements in T1D patients.

Main Methods:

  • Review of Phase 2 and 3 clinical studies, including the EASE trials, investigating empagliflozin in T1D.
  • Analysis of data on HbA1c, body weight, glucose variability, insulin dosage, hypoglycemia, genital infections, and diabetic ketoacidosis (DKA).

Main Results:

  • Empagliflozin demonstrated significant improvements in HbA1c, body weight, glucose variability, and reduced total daily insulin use in T1D patients.
  • No increased risk of severe hypoglycemia was observed; however, genital infections were more prevalent.
  • The EASE program using low-dose empagliflozin showed metabolic benefits with a lower DKA risk, though patient education is key to managing DKA risk at all doses.

Conclusions:

  • Empagliflozin, like other SGLT2 inhibitors, shows potential as an effective glucose-lowering agent in T1D.
  • Current evidence supports its benefits, but empagliflozin is not yet approved for T1D treatment.
  • Clinicians must balance the therapeutic advantages against potential side effects, particularly the risk of DKA.