Endocrine Abstracts

Ntroduction and Aim: The use of sodium-glucose cotransporter type 2 (SGLT-2) inhibitors has importantly improved the management of patients with type 2 diabetes mellitus. The aim of the present study was to evaluate the renal and metabolic effects after one year of SGLT-2 use in a cohort of patients with type 1 diabetes mellitus (T1D) treated with continuous subcutaneous insulin infusion (CSII).

Methods: Retrospective observational study in adult patients with T1D under treatment with CSII who started SGLT-2 in a tertiary hospital. Clinical, metabolic and glycometric parameters of Continuous Glucose Monitoring (CGM), including the Time in Tight Range (TTR) and the Glycemia Risk Index (GRI) were obtained at baseline and at 6 and 12 months of follow-up, as well as the existence of complications derived from the use of SGLT-2.

Results: 18 patients were selected (55.6% female) with a mean age of 41.5 [39-48] years and 20 [11.8-29] years of T1D evolution were evaluated. Initially 22.2% met criteria for diabetic nephropathy. After 12 months of treatment, there was an increase in Time in range 70-180 mg/dl (TIR) (63.0 [53.0-74.0] vs 78.0[66.0-85.0]%; P<0.01) and a decrease in GRI (39.2[28.4-43.8] vs 20.0[14.2-33.2]; P<0.05), Time above 180 mg/dl (TAR) (31.5[20.5-39.5] vs 21.0[13.3-30.3]%; P<0.05) and Coefficient of Variation (CV) (34.8[32.8-38.4] vs 31.5[29.1-36.7]%; P<0.05), as well as a trend towards better TTR (45.0[32.5-57.5] vs 51.0[38.3-59.8]%; P=ns). No changes were observed in time below 70 mg/dl (TBR) (2.0[1.0-4.8] vs 2.0[1.0-2.8]%; P=ns) or in glycosylated hemoglobin A1c (7.3[6.6-7.8] vs 7.1[6.6-7.6]%; P=ns). In terms of renal parameters, at 12 months of treatment, a decrease in albuminuria (AlbU) was observed (11.5[3.8-107.9] vs 7.8[3.1-13.6]mg/l; P<0.01) as well as an increase in serum urea levels (34.0[27.8-36.3] vs 43.0[33.0-51.0]mg/dl, P<0.05], with no worsening of creatinine levels (0.9[0.8-1.0] vs 1.0[0.8-1.0]mg/dl, P=ns]. At 6 months follow-up, albumin-creatinine ratio (ACR) levels decreased in 2 patients with initial ACR > 300 mg/g: 1 achieved ACR less than 30 mg/dl (29.6 mg/g), and 1 less than 300 mg/dl (161 mg/g). Treatment with SGLT-2 was withdrawn in 3 patients (17.3%): 1 case due to gestational desire and 2 because of genitourinary infections. No case of ketoacidosis was documented during follow-up.

Conclusion: The use of SGLT-2 in patients with T1D under treatment with CSII led to an increase in TIR, with a significant decrease in GRI, TAR and CV, as well as improvement in renal parameters (AlbU, ACR), without the presence of serious complications during follow-up. The use of SGLT-2 may be a good therapeutic alternative in patients with T1D treated with CSII.