Can SGLT2 inhibitors be used in people with type 1 diabetes?

This study investigated the safety and effectiveness of SGLT2 inhibitors, in addition to insulin, in people with type 1 diabetes (T1D). It determined that SGLT2 inhibitors were safe and effective.

SGLT2 is a protein in the kidneys that is important in controlling blood glucose levels. It allows glucose to re-enter the blood from the kidneys. SGLT2 inhibitors, such as dapagliflozin (Farxiga) or canagliflozin (Invokana), are a type of treatment that prevents this. They are currently FDA-approved for type 2 diabetes, but not for T1D.

Insulin is the main treatment for T1D. However, intensive insulin therapy is associated with side effects, like weight gain and hypoglycemia (dangerously low blood glucose). SGLT2 inhibitors may help control blood glucose levels in people with T1D. This may reduce the amount of insulin needed, and thus reduce the risk of side effects. However, very few studies have examined SGLT2 inhibitors in people with T1D.

This study examined data from 4 other studies. 485 adults with T1D participated in these studies. 323 participants received an SGLT2 inhibitor plus insulin. The other 162 received a placebo (drug with no active effect) instead of an SGLT2 inhibitor. The studies lasted between 4 and 18 weeks.

Those who received SGLT2 inhibitors had greater reductions in HbA1c (measures average blood glucose over the last 3 months) than the placebo group. Participants who took dapagliflozin had the greatest reduction. Those who received SGLT2 inhibitors also had larger reductions in weight and insulin dose. Canagliflozin was associated with the greatest reductions in weight. This may have been because patients who received canagliflozin were treated for a longer time than those who received other SGLT2 inhibitors.

Higher doses of SGLT2 inhibitors lead to greater reductions in HbA1c and body weight than lower doses. Treatment lasting more than 3 months resulted in greater weight loss than treatment lasting less than 3 months.

There were no major differences in the rates of hypoglycemia, infection, and overall side effects between the two groups. Participants who received SGLT2 inhibitors were more likely to experience diabetic ketoacidosis (a life-threatening emergency).

The study concluded that SGLT2 inhibitors are safe and effective in people with T1D, when used with insulin.

There were large differences between the individual studies examined in this study (such as the type of SGLT2 inhibitor used, the dose used, the duration of treatment). This may have affected the results.

Discuss the use of SGLT2 inhibitors, and other non-insulin drugs, with your physician.