Glycemic Effects Of Sglt-2 Inhibitor Canagliflozin In Type 1 Diabetes Patients Using The Dexcom G4 Platinum Cgm

Argento, Nicholas B.; Nakamura, Katherine

doi:10.4158/ep151016.or

Cited by 22 publications

(22 citation statements)

References 31 publications

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“…20 In another CGM study, significant reductions in mean blood glucose, CGM standard deviation, time spent in hyperglycemia, HbA1c, weight, systolic blood pressure (SBP), and total daily insulin dose were reported in 27 patients with canagliflozin as add-on to insulin. 21 Similar benefits have been reported with ipragliflozin and remogliflozin in small pilot studies. 14,22 In a recent meta-analysis of three randomized controlled trials including 178 patients, SGLT2 inhibitor use was associated with reduction in fasting blood glucose and insulin dosage, with no significant risk of urinary tract infections, genital infections or diabetic ketoacidosis (DKA).…”

Section: Clinical Evidence With Sodium-glucose Co-transporter-2 Inhibsupporting

confidence: 63%

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

Priya¹,

Kalra²,

Bhambri³

2017

US Endocrinology

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There is an unmet need for adjunctive non-insulin-based therapies in type 1 diabetes (T1D). Weight gain, recurrent hypoglycemia and suboptimal glycemic control remain significant challenges. Sodium-glucose co-transporter-2 (SGLT2) inhibitors and dual inhibitors of sodium-glucose co-transporter-1 (SGLT1) and SGLT2 may have a potential role as an add-on therapy to insulin. The benefits include improved glycemic control, weight reduction, and reduced insulin dose requirement. However, the risk of diabetic ketoacidosis with SGLT2 inhibitors is significant and the diagnosis may be delayed due to absence of significant hyperglycemia. At present, SGLT2 inhibitors are not approved for use in T1D, and the risks should be discussed at length with the patient. We propose strategies to minimize the risk of diabetic ketoacidosis associated with off-label use of SGLT2 inhibitors in T1D.

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Section: Clinical Evidence With Sodium-glucose Co-transporter-2 Inhibsupporting

confidence: 63%

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

Priya¹,

Kalra²,

Bhambri³

2017

US Endocrinology

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“…It performs better than other commercially available CGM in comparative assessments of 48-h duration [8]. The DG4P system can be used in real-time mode to improve glucose control and in patients on sensor-augmented insulin pump [22], or in blind retrospective mode for clinical diagnosis of specific glucose trends in selected patients [23] or for clinical research [4,24]. The FSL is a patient-dedicated interstitial glucose monitoring system intended to substitute for SMBG.…”

Section: Discussionmentioning

confidence: 99%

Head-to-head comparison between flash and continuous glucose monitoring systems in outpatients with type 1 diabetes

Bonora

Maran

Ciciliot

et al. 2016

J Endocrinol Invest

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“…Similar findings have also been reported in clinical practice. A retrospective study in 27 patients with type 1 diabetes treated with canagliflozin 100 mg reported two cases of DKA that developed due to insulin pump failure and cessation of insulin therapy (16). A recent case series described 13 episodes of DKA in patients with type 1 (n = 7) and type 2 (n = 2) diabetes treated with SGLT2 inhibitors (18).…”

Section: Discussionmentioning

confidence: 99%

Diabetic Ketoacidosis With Canagliflozin, a Sodium–Glucose Cotransporter 2 Inhibitor, in Patients With Type 1 Diabetes

et al. 2016

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OBJECTIVETo assess the incidence of serious adverse events (AEs) of diabetic ketoacidosis (DKA) with canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as an add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODSIn this 18-week, randomized, double-blind, phase 2 study, patients (N = 351; HbA 1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion received canagliflozin 100 or 300 mg or placebo once daily. The incidence of ketone-related AEs, defined as any event from a prespecified list of preferred terms (i.e., acidosis, blood ketone body increased, blood ketone body present, DKA, diabetic ketoacidotic hyperglycemic coma, ketoacidosis, ketonemia, ketonuria, ketosis, metabolic acidosis, urine ketone body present), including serious AEs of DKA, was assessed based on AE reports. RESULTSAt week 18, the incidence of any ketone-related AE with canagliflozin 100 and 300 mg was 5.1% (n = 6 of 117) and 9.4% (n = 11 of 117), respectively; no patients in the placebo group experienced a ketone-related AE. The incidence of serious AEs of DKA was 4.3% (n = 5 of 117) with canagliflozin 100 mg and 6.0% (n = 7 of 117) with canagliflozin 300 mg; all serious events occurred in the presence of circumstances that are known to potentially precipitate DKA (e.g., infection, insulin pump failure). Among the 12 patients with a serious AE of DKA, blood glucose levels ranged from 9.4 to >44.4 mmol/L (170 to >800 mg/dL). Baseline characteristics were generally similar in patients with and without a ketone-related AE. CONCLUSIONSCanagliflozin was associated with an increased incidence of serious AEs of DKA in patients with type 1 diabetes inadequately controlled with insulin. Mitigation strategies are needed for use in future clinical trials to reduce the risk of DKA with canagliflozin treatment in patients with type 1 diabetes.Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes that is characterized by hyperglycemia, metabolic acidosis, and an increase in circulating ketones (1,2). DKA results from a combination of reduced insulin levels and increased levels of regulatory hormones, such as glucagon and cortisol (1,2). This decrease in insulin and increase in counterregulatory hormones

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Glycemic Effects Of Sglt-2 Inhibitor Canagliflozin In Type 1 Diabetes Patients Using The Dexcom G4 Platinum Cgm

Cited by 22 publications

References 31 publications

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

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

Head-to-head comparison between flash and continuous glucose monitoring systems in outpatients with type 1 diabetes

Diabetic Ketoacidosis With Canagliflozin, a Sodium–Glucose Cotransporter 2 Inhibitor, in Patients With Type 1 Diabetes

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