Canagliflozin – an add-on to insulin therapy in type 1 diabetes?

This study investigated the safety and effectiveness of canagliflozin (Invokana) as an add-on to insulin therapy in type 1 diabetes. The study concluded that canagliflozin caused a decrease in HbA1c, body weight and insulin dose in adults with type 1 diabetes.

The standard treatment option for type 1 diabetes is insulin. However, there are limitations of insulin therapy. Insulin therapy can lead to weight gain, low blood sugars and blood sugar fluctuations. Thus, new therapies are needed to help patients with type 1 diabetes to improve blood sugar level control. 

Canagliflozin is a drug approved for the treatment of adults with type 2 diabetes. It reduces blood sugar levels by releasing sugar from the body through the urine. This therapy may represent a complementary treatment option to insulin for patients with type 1 diabetes. 

This study looked at the safety and effectiveness of canagliflozin in type 1 diabetes. 351 patients were included in this study. Patients continued with insulin therapy and were randomly assigned to either a 100 mg dose of canagliflozin, a 300 mg dose of canagliflozin or a placebo (substance with no effect on the body) for 18 weeks.

36.9% of patients taking the 100 mg dose of canagliflozin and 41.1% of patients taking the 300 mg dose had a reduction in HbA1c levels and no increase in body weight. This is compared to the placebo group, where only 14.5% had both HbA1c reduction and no increase in body weight.  4.3 % of patients taking the 100 mg dose of canagliflozin and 6% of patients taking the 300 mg dose experienced diabetic ketoacidosis (DKA, a build-up of acid in the blood due to dangerously high blood glucose levels). None of the patients in the placebo group experienced DKA. The occurrence of hypoglycaemia (low blood sugar levels) was similar across all the groups.

The current study concluded that canagliflozin was associated with a decrease in HbA1c, body weight and insulin dose in adults with type 1 diabetes that is not well controlled with insulin.

DKA is potentially life threatening in patients with type 1 diabetes. 

Discuss this treatment option with your doctor.