Use of SGLT-2 Inhibitors in Patients With Type 1 Diabetes Mellitus

Abstract

Introduction: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are the newest class of oral antihyperglycemic medications approved for the treatment of type 2 diabetes mellitus (DM2). Although they are not approved for use in type 1 diabetes mellitus (DM1), SGLT2 inhibitors may help DM1 patients achieve their HbA1c goals by decreasing their insulin requirements, without inducing hypoglycemic episodes and weight gain. Methods: We conducted a retrospective chart review of 26 patients with DM1 treated with off-label SGLT-2 inhibitors. The primary objective was change in HbA1c and weight. The secondary objective was assessing the effect on insulin requirements, blood pressure, and lipid profile. Results: Improvement in HbA1c level was seen in 20 of the 26 patients (77%) after initiation of SGLT-2 inhibitors. The average decrease in HbA1c was 0.32% ( P = .032), with changes seen as early as 1 month posttherapy and maintained with continued SGLT-2 inhibitor use. There was a trend toward weight loss that was not significant. No significant changes in blood pressure or lipid profiles were seen except for a slight increase in low-density lipoprotein ( P = .049). No patient developed euglycemic diabetic ketoacidosis. Three patients discontinued therapy due to uncontrolled genital yeast infections. Conclusion: SGLT-2 inhibitors can be a useful adjunctive therapy in patients with DM1 to improve glycemic control and weight. Although our study did not show any significant changes in the metabolic profile and insulin requirements in these patients, a larger sample size may yield different results.

Estimating Type 2 Diabetes Prevalence: A Model of Drug Consumption Data

“…Consequently, the data about the off-label use of medicines are scarce, as it is often associated with a practice with no legal framework [69]. The off-label use of ADs is not well documented, but some studies suggested the use of NADs for T1DM [70][71][72][73][74][75], obesity [70,76], polycystic ovarian syndrome [77][78][79], dermatological diseases [80,81], and as a senolytic [82][83][84]. Recently, the European Medicines Agency approved the SGLT inhibitors dapagliflozin and sotagliflozin as adjuvant treatments to insulin for T1DM in adults [85], and insulins were already recommended in T2DM in the previous guidelines.…”