Case Reports That Illustrate the Efficacy of SGLT2 Inhibitors in the Type 1 Diabetic Patient

Abstract

SGLT2 inhibitors are only approved for use in adults with type 2 diabetes. However, because SGLT2 inhibitors have a mechanism of action that does not require the presence of endogenous insulin, these drugs should also be efficacious in type 1 diabetes where endogenous insulin production is greatly reduced or absent. Herein, I present five cases which illustrate the benefits of utilizing an SGLT2 inhibitor with type 1 diabetes. In these cases the use of SGLT2 inhibitors resulted not only in better glycemic control in most patients but also in some patients' less hypoglycemia, weight loss, and decreased doses of insulin. In type 1 diabetes Candida albicans vaginitis and balanitis may occur more frequently than in type 2 diabetes. These cases show that a large randomized clinical trial of SGLT2 inhibitors in type 1 diabetes needs to be performed.

The impact of SGLT2 inhibitors, compared with insulin, on diabetic bone disease in a mouse model of type 1 diabetes

“…By increasing urinary glucose excretion, they are effective in improving glycemic control in persons with type 2 diabetes (T2D), whether as monotherapy (2, 3), or as co-therapy, in combination with insulin (4, 5) or with a variety of oral hypoglycemic agents (6-9). However, recent studies also suggest that SGLT2Is may be efficacious, as adjunct-to-insulin therapy, in T1D (10), and off-label use of SGLT2Is in T1D is being increasingly reported (11-13). The use of SGLT2 inhibition for the treatment of all diabetes is expected to increase, because of: 1) the unique mechanism of action (increased glycosuria) (14, 15); 2) the greater durability of effect, compared with other drug classes (16); 3) the preferential efficacy in patients with more poorly controlled diabetes (2, 17); 4) the concurrent beneficial reductions in weight and blood pressure that occur in persons with T2D taking these medications (17); 5) the potential applicability to both T1D and T2D; and 6) the potential to minimize hypoglycemia risk in intensively managed T1D (13).…”

Cetoacidosis diabética euglicémica asociada a inhibidor de cotransportador de sodio glucosa Tipo 2 en paciente con diabetes Mellitus Tipo 1

“…Esta disociación entre glicemia y glucosuria, en el contexto clínico de nuestra paciente con DM1, mal control metabólico y sobrepeso 12 fue lo que llevó a sospechar en el uso de algún fármaco iSGLT2.…”

“…Algunos trabajos también han demostrado una menor incidencia de hipoglicemia. Sin embargo, tales estudios son de corta duración, y con un escaso número de pacientes participantes [12][13][14] . La racionalidad del uso de este grupo de fármacos en pacientes diabéticos radica en que no requieren indemnidad de la célula beta pancreática 4 .…”

Sodium-glucose Co-transporter-2 Inhibitors in Type 1 Diabetes—a Dangerous Ally

“…12 Dapagliflozin increased UGE by 72-88 g per 24 hours in a dose ranging study in 70 T1D adults with reduction in daily insulin dose requirements by 16.2-19.3%. 13,14 There were significant reductions in 24-hour average glucose and glycemic variability, without any unexpected short-term safety concerns over 2 weeks.…”

“…The prevalence of overweight and obesity among newly diagnosed T1D subjects was 21-22% in the [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] year age group in the Pediatric Diabetes Consortium and the SEARCH for Diabetes in Youth study. 1,2 This has been attributed to a general worldwide increase in prevalence of obesity and similar risk factors such as family history, ethnicity, and sedentary lifestyle may be contributory.…”