Participant and physician perspectives on the use of SGLT2 inhibitors in type 1 diabetes

Sodium-glucose co-transporter inhibitors (SGLT2i) have proven cardiorenal benefits in type 2 diabetes and are promising as adjunct-to-insulin therapy in participants with type 1 diabetes (T1D). However, clinical use in T1D has been limited owing to a lack of regulatory approval and the augmented risk of diabetic ketoacidosis (DKA). Participant and physician input is critical in understanding how and when the risk-benefit ratio with these therapies is perceived to be favourable for users. This study aimed to explore how risks and benefits of SGLT2i are considered by participants with T1D and physicians who treat the condition.

We used a qualitative descriptive study design, in which we conducted semi-structured interviews with people with T1D and physicians who treat this population. Participants were sampled from multiple Canadian sites via online recruitment. Transcripts were analysed inductively using conventional qualitative content analysis to identify themes.

We interviewed 24 participants with long-standing T1D, whose duration of living with diabetes ranged from 8 to 62 years. We also interviewed 7 physicians, including endocrinologists and nephrologists with a range of 4 to 20+ years in practice. Our analysis revealed five major themes: (i) A prevailing inclination to 'stay in the safe zone', reflecting hesitancy to move beyond established therapeutic boundaries; (ii) A sense of 'feeling the disconnect', characterized by divergent lenses between patients and clinicians, and tension regarding who holds expertise in T1D care; (iii) Ongoing efforts to reconcile the trade-offs between risks and benefits when considering new therapeutic strategies; (iv) A cautiously optimistic search for a path forward, marked by both anticipation and restraint; and (v) The need for personalization of care-the overarching theme.

While there is great interest and motivation toward the use of SGLT2i among people with T1D and the physicians who treat them, there is also a clear understanding of the need for personalization of therapy and support for robust evidence to inform care.