Use of Sodium-Glucose Co-Transporter-2 Inhibitors in Type 1 Diabetics: Are the Benefits Worth the Risks?

Abstract

The mainstay of treatment for type 1 diabetes is insulin. The use of insulin for tight glycemic control is the key to preventing micro-and macrovascular complications, but it can also lead to hypoglycemic episodes. Therefore, there is a need for the introduction of a drug that can maintain glucose levels within a safe range without increasing the risk of hypoglycemia. For this reason, SGLT2 (sodium-glucose co-transporter-2) inhibitors has been a hot topic in the last couple of years. They have been proved very efficient in treating type 2 diabetes. Many trials on the safety and efficacy of SGLT2 inhibitors have been done on type 1 diabetics. Some other studies have also been done that prove their benefits in increasing arterial efficacy and reducing GFR (glomerular filtration rate). This review article discusses the benefits and risks. The literature search was performed using PubMed, and after applying the inclusion and exclusion criteria, 16 published papers were found. All relevant articles on the topic have been included. Our review has shown that the benefits of SGLT2 inhibitors outweigh their risks. Their benefits include good glycemic control, HBA1c (glycated haemoglobin) reduction, weight loss, and blood pressure improvement. Furthermore, improvement in GFR and arterial efficacy is also significant. Side effects such as UTI (urinary tract infection) and genital infection have been observed, but their incidence is low. However, DKA (diabetic ketoacidosis) and hypoglycemia are severe side effects that should be highlighted. Hypoglycemia can be prevented by strictly monitoring blood sugar levels. The patient must be educated and counseled about DKA and its symptoms. This will ensure the safety of the patient as euglycemic DKA can prove fatal if not diagnosed earlier. So, SGLT2 inhibitors can be used as an effective drug to control blood sugar levels in type 1 diabetes, especially in patients with a BMI higher than 30. It will not only achieve the treatment goals but can also decrease the morbidity and mortality of the patients. However, more studies need to be done to fully understand DKA caused by SGLT2 inhibitors.

An Unsuspected Case of Euglycemic Diabetic Ketoacidosis With Twists

“…Prior to the presentation, our patient also endorsed a significant weight loss. Therefore, our patient's age and low BMI prompted the evaluation for LADA, although she did not endorse any family history of LADA [9]. Patients with LADA are thought to have a progressive course of autoimmune diabetes, which renders the diagnosis difficult [10].…”

SGLT2 Inhibitor Significantly Improved Plasma Glucose Levels in a Patient with Latent Autoimmune Diabetes of Adults: A Case Report

“…SGLT2is contribute to achieve treatment goal in patients with T1D [1,3]. By contrast, to date, the application of SGLT2is among patients with LADA have not been comprehensively assessed [1]. In our case, as shown in Figure 1, to date, mean HbA1c levels have been maintained at < 7.0 % for over 9 years without hospitalization and adverse effects including diabetes ketoacidosis (DKA) after ipragliflozin treatment was started.…”

“…Latent autoimmune diabetes of adults (LADA) is a type of diabetes mellitus (DM) with characteristics of both type 1 diabetes (T1D) and type 2 diabetes (T2D). LADA is a disease of adults and the Immunology for Diabetes Society (IDS) has specified three criteria for its diagnosis: 1) onset of DM after age 35, 2) positivity for either of the known anti-islet autoantibodies, 3) insulin treatment required for more than 6 months after the diagnosis of DM [1].…”

“…SGLT2is contribute to achieve treatment goal in patients with T1D [1,3]. By contrast, to date, the application of SGLT2is among patients with LADA have not been comprehensively assessed [1].…”

Imeglimin Improved Plasma Glucose Levels in Patients With Latent Autoimmune Diabetes of Adults: Report of 2 Cases

“…The use of oral agents such as imeglimin for treating LADA has not been thoroughly studied [ 2 ]. We present 2 cases of LADA treated with imeglimin.…”