Endocrine Abstracts

Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors were recently approved as adjunctive treatment for type 1 diabetes (T1D), contributing to better glycemic control, cardiovascular and renal protection. Aim: access the efficacy and safety of these antidiabetic agents in selected T1D patients.

Methods: Evaluation of medical records of T1D patients starting SGLT-2 inhibitors between August 2018 and October 2019.

Results: 24 T1D patients (58.3% females, n = 14), 41.5 ± 12.32 years, on multiple daily injections (n = 23) or insulin pump therapy (IPT; n = 1), initiating metformin/dapagliflozin 850/5 mg od (n = 16), metformin/dapagliflozin 1000/5 mg od (n = 5), and empagliflozin 10 mg od (n = 3). Body mass index (BMI) was 27.6 ± 3.6 kg/m². Diabetes duration was 17.5 ± 9.95 years, 25% with high blood pressure, 45.8% dyslipidemic, 33.3% had retinopathy, 13% nephropathy, 1 patient neuropathy, and 2 (8.7%) history of coronary heart disease. Mean glycated hemoglobin (HbA1c) was 8.3 ± 0.88%, systolic blood pressure (SBP) 132.0 ± 15.32 mmHg, diastolic blood pressure (DBP) 76.7 ± 12.56 mmHg, serum creatinine 0.7 ± 0.16 mg/dl, glomerular filtration rate (GFR) 110.7 ± 25.5 ml/min. Three (12.5%) patients abandoned therapy in the first 3 months due to side effects (genital infection, diuretic effect, diarrhea). One male stopped the medication temporarily (genital infections that eventually ceased). The patient on IPT suspended SGLT2 inhibitor for difficult compliance on ketone bodies surveillance and desire to keep IPT. No episodes of DKA were reported. 20 patients were followed for 10.1 ± 3.56 months: there was a reduction of 0.7% in HbA1c (8.2 ± 0.94% vs 7.5 ± 0.72%; p<0.001), loss of 3.0 ± 3.19 kg (75.8 ± 13.99 vs 72.8 ± 13.77 kg; P = 0.001), improvement in BMI (27.4 ± 3.68 vs 26.4 ± 3.72 kg/m²; P = 0.001), and reduction of 6.8 ± 8.80 IU in total daily dose (TDD) of insulin (n = 11; 62.7 ± 22.22 vs 55.9 ± 22.00 IU; P = 0.028). Overall reduction occurred in basal insulin dose (total basal dose 31.0 ± 12.35 vs 26.7 ± 12.08 IU; P = 0.075), with no statistical significance. Despite overall reduction, the differences were not significant for SBP (P = 0.127), DBP (P = 0.363), total cholesterol (P = 0.132), and LDL cholesterol (P = 0.077), probably due to the sample size. Renal function was preserved during the follow-up: no changes in serum creatinine (0.73 ± 0.16 vs 0.73 ± 0.13 mg/dl; P = 0.872) and GFR (110.9 ± 25.65 vs 109.6 ± 23.9 ml/min; P = 0.741). There were no changes in patient’s blood count (hemoglobin 13.7 ± 2.11 vs 13.9 ± 2.22 g/dl, P = 0.550; erythrocyte count 4.8 ± 0.51 vs 4.8 ± 0.58, P = 0.605).

Conclusion: SGLT-2 inhibitors are an effective adjunct therapy to insulin in T1D, improving glycemic control but also patient’s metabolic profile. Careful selection of patients ensures safety of this therapy. Longer follow-up would improve our knowledge of its real-life benefits.