Can empagliflozin help control blood sugar levels in patients with Type 1 Diabetes?

This study investigated if giving empagliflozin (Jardiance) in addition to normal insulin therapy to patients with Type 1 Diabetes (T1D) could help to better control blood sugar. They found that empagliflozin and insulin together improved blood sugar control and helped weight loss in patients with T1D.

The aim of treatment in T1D is to normalize blood sugar. Currently, this is done by using insulin injections. The side effects of insulin are weight gain and blood sugars dropping too low (hypoglycemia).

Empagliflozin is a blood sugar lowering drug used in the treatment of type 2 diabetes. It is an SGLT2 inhibitor. It works by blocking the uptake of sugar in the kidney back into the blood. Instead, the sugar gets removed from the body in the urine. The use of empagliflozin in T1D is still under investigation.

The study included 1707 patients with uncontrolled T1D. Patients were randomly assigned to receive either empagliflozin or a placebo (a drug that has no effect on the body) along with their normal insulin. Empagliflozin was given as 3 doses: 25 milligrams, 10 milligrams, or 2.5 milligrams. Blood sugar control was measured through the HbA1c (an average of blood sugar levels of the past 3 months).

After 26 weeks of treatment, patients who received empagliflozin had up to 0.54% reductions in their HbA1c compared to placebo. This reduction was higher with the 10 and 25 milligrams dose. 2.5 milligrams empagliflozin also led to a HbA1c reduction by 0.28%. 

In addition, patients treated with empagliflozin experienced up to 3.4 kg of weight loss and a reduction in blood pressure. The weight loss was higher with higher doses of empagliflozin. The empagliflozin-treated patients needed lower doses of insulin throughout the study.

Patients treated with empagliflozin were up to 37% less likely to have an episode of hypoglycemia. However, these patients experienced a higher number of genital infections and a higher rate of a serious complication called diabetic ketoacidosis. This was especially true for the 10 and 25 milligrams doses.

This study indicated that using empagliflozin as an add-on therapy to insulin in patients with type 1 diabetes can help to better control blood sugar. However, the authors suggested that it increased the risk of complications.

This study was funded by Boehringer Ingelheim and Eli Lilly, the manufacturer of empagliflozin.