SGLT inhibitor adjunct therapy in type 1 diabetes

Rory McCrimmon (Lead / Corresponding author), Robert R. Henry

    Research output: Contribution to journalReview articlepeer-review

    66 Citations (Scopus)
    217 Downloads (Pure)

    Abstract

    Non-insulin adjunct therapies in type 1 diabetes have been proposed as a means of improving glycaemic control and reducing risk of hypoglycaemia. Evidence to support this approach is, however, scant and few pharmacological agents have proved effective enough to become part of routine clinical care. Recent short-term Phase II trials and 24 week Phase III trials provide initial support for the use of sodium–glucose cotransporter (SGLT) inhibitors in type 1 diabetes. Two international, multicentre, randomised, controlled clinical trials, Dapagliflozin Evaluation in Patients with Inadequately Controlled Type 1 Diabetes (DEPICT-1) and inTandem3, have reported that SGLT inhibition with dapagliflozin and sotagliflozin, respectively, confer additional benefits in terms of a 5–6 mmol/mol (0.4–0.5%) reduction in HbA1c accompanied by weight loss and reductions in total daily insulin doses. The reduction in HbA1c does not come with a significantly increased risk of hypoglycaemia but does carry an increased risk of diabetic ketoacidosis and mycotic infections. These results suggest that SGLT inhibition will have a place in the management of type 1 diabetes. Longer-term clinical trials (≥52 weeks) and observational cohort studies are needed to determine any additional benefits or adverse effects of this adjunct therapy and to determine which group of patients may benefit most from this approach. In addition, use of SGLT inhibitors in routine type 1 diabetes care will require specific patient and healthcare professional educational packages to ensure patient safety and to minimise risk.
    Original languageEnglish
    Pages (from-to)2126-2133
    Number of pages8
    JournalDiabetologia
    Volume61
    Issue number10
    Early online date22 Aug 2018
    DOIs
    Publication statusPublished - Oct 2018

    Keywords

    • Clinical trials
    • Diabetic ketoacidosis
    • GLP-1 receptor agonist
    • HbA
    • Hypoglycaemia
    • Insulin
    • Review
    • Sodium–glucose cotransporter inhibitors
    • Type 1 diabetes
    • Weight

    ASJC Scopus subject areas

    • Internal Medicine
    • Endocrinology, Diabetes and Metabolism

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