Real-world Evidence of Efficacy and Safety of SGLT2 Inhibitors as Adjunctive Therapy in Adults With Type 1 Diabetes: A European Two-Center Experience

• Published in: Diabetes care Vol. 45; no. 3; pp. 650 - 658
• Main Authors: Palanca, Ana, van Nes, Falco, Pardo, Felipe, Ampudia Blasco, F. Javier, Mathieu, Chantal
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.03.2022
• Subjects: Adult; Adults; Adverse events; Albumins; Creatinine; Demography; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - chemically induced; Diabetes Mellitus, Type 1 - drug therapy; Diabetic ketoacidosis; Diabetic Ketoacidosis - chemically induced; Epidermal growth factor receptors; Evaluation; Glomerular filtration rate; Humans; Hypoglycemia; Hypoglycemic Agents - adverse effects; Inhibitor drugs; Insulin; Insulin - adverse effects; Ketoacidosis; Ketosis; Na+/glucose cotransporter; Renal function; Retrospective Studies; Safety; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Subgroups; Weight loss
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc21-1584

To evaluate real-world efficacy and safety of sodium-glucose cotransporter 2 inhibitor (SGLT2i) use in combination with insulin in people with type 1 diabetes. We conducted a retrospective cohort European two-center study. Data on demographics, HbA1c, weight, insulin use, renal function, and adverse events were collected for 199 adults with type 1 diabetes who initiated a SGLT2i adjunct to insulin. Subgroup analyses were performed to identify who benefited most and who was more at risk for adverse events. Overall, significant reductions in mean HbA1c (-0.5%), weight (-2.9 kg), and daily insulin (-8.5%) were achieved after 12 months. The greatest reduction in HbA1c was obtained in individuals with baseline HbA1c >8% (-0.7% [64 mmol/mol]). The most weight loss was observed in subjects with BMI >27 kg/m2 (-3.5 kg). Individuals with baseline estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 showed an increase in eGFR (4.5 mL/min/1.73 m2), whereas those with urinary albumin-to-creatinine ratio (UACR) >15 mg/g showed a decrease in UACR (-16.6 mg/g). Fifty-seven individuals (28.6%) reported adverse events: 45 with genital infections (22.6%), 5 ketosis episodes (2.5%), and 7 diabetic ketoacidosis (DKA) (3.5%). No severe hypoglycemia events were reported. Our real-world data on SGLT2i showed promising results in reductions in HbA1c, weight, and insulin requirements in type 1 diabetes. Benefits were more pronounced in individuals with higher baseline HbA1c and BMI. DKA remained a major concern, despite educational measures. Further real-life evidence is still required for evaluation of SGLT2i longer-term effects and their impact on reno-cardiovascular outcomes.