[SGLT 2 inhibitors in Type 1 diabetes]

Area of Science:

• Endocrinology
• Metabolic Diseases
• Pharmacology

Background:

• Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are approved for Type 1 diabetes (T1D) treatment.
• Dapagliflozin, an SGLT2i, shows benefits like reduced HbA1c, weight, and insulin dose, with increased time in range.
• A notable side effect is an increased risk of diabetic ketoacidosis (DKA).

Purpose of the Study:

• To review the risk and presentation of diabetic ketoacidosis (DKA) in Type 1 diabetes (T1D) patients treated with SGLT2 inhibitors.
• To highlight the potential for euglycaemic DKA in this patient population.

Main Methods:

• Literature review focusing on SGLT2 inhibitor use in T1D.
• Analysis of studies reporting DKA events in T1D patients on SGLT2 inhibitors.
• Examination of DKA presentation, including blood glucose levels.

Main Results:

• SGLT2 inhibitor use in T1D is associated with a significant increase in DKA risk, from 1.9% to 4.0%.
• Diabetic ketoacidosis (DKA) in patients on SGLT2 inhibitors can present with normal or near-normal blood glucose levels (euglycaemic DKA).

Conclusions:

• Physicians must be aware that DKA can manifest with normal glycemia in T1D patients using SGLT2 inhibitors.
• Vigilance for euglycaemic DKA is crucial for timely diagnosis and management in T1D patients on SGLT2i therapy.