Dapagliflozin as an adjunct therapy to insulin in the treatment of patients with type 1 diabetes mellitus

Tamez, Hector; Tamez, Alejandra L.; Garza, Lucas A.; Hernandez, Mayra I.; Polanco, Ana C.

doi:10.1186/s40200-015-0210-x

Cited by 31 publications

(30 citation statements)

References 16 publications

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“…13,14 In another 24-week study in T1D subjects, dapagliflozin reduced fasting glucose, postprandial glucose, HbA1c, total cholesterol, LDL cholesterol, and triglycerides with no significant adverse events. 15 Similar benefits were seen when dapagliflozin was added to ongoing insulin and liraglutide therapy. 16 Empagliflozin significantly lowered 24-hour UGE in 75 T1D individuals.…”

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

confidence: 84%

“…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.…”

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confidence: 99%

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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 Inhibmentioning

confidence: 84%

mentioning

confidence: 99%

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

Priya¹,

Kalra²,

Bhambri³

2017

US Endocrinology

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“…The use of these drugs appears to be increasing in young people with T1D despite not being approved 1,[27][28][29][30] . This case illustrates the risk of using these promising drugs when long-term safety studies are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…In adults with Type 2 Diabetes (T2D), Dapagliflozin improves glycosylated hemoglobin (HbA1c) and fasting blood glucose both as monotherapy and in combination with other drugs [3][4][5][6] . Some studies have suggested that SGLT2-I could be useful as an adjuvant to insulin therapy in T1D to improve glycemic control and weight [7][8][9] . However, it has not been approved in children or in T1D.…”

Section: Introductionmentioning

confidence: 99%

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso

Ramírez

Román

2017

Rev. chil. pediatr.

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Introduction: Dapagliflozin, an insulin-independent sodium-glucose cotransporter 2 inhibitor (SGLT2-I) induces glycosuria and reduces hyperglycemia in adults with type 2 diabetes. Objective: To present an "euglycemic" diabetic ketosis in an adolescent with type 1 diabetes (T1D) receiving dapagliflozin, to alert about the risk of a drug not approved in children nor in T1D. Case report: A 17 years old adolescent with T1D during 9 years, was started on dapagliflozin 10 mg/day to reduce insulin dose and weight. During 11 months on treatment, capillary ketones were undetectable and she exhibited a reduction in body mass index 23.9 to 21.1 kg/m 2 , basal insulin 40 to 17 U, glycated hemoglobin 8.3 to 7.5%, capillary glucose 175 to 161 mg/dl and glucose variability (standard deviation) 85 to 77. Suddenly nausea and vomits appeared. The patient was on an insulin pump and well calibrated continuous glucose monitoring, showing stable glucose levels under 200 mg/dl, and an insulin bolus was delivered. Vomiting without hyperglycemia persisted; three hours later, she was severely dehydrated and fainting, with ketones 4.6 nmol/l and glucose 224 mg/dl. She received IV saline fluids, ondansetron, carbohydrates and several insulin boluses. Hydration and general condition improved soon, however despite several insulin doses, ketosis continued for 24 hours. It is remarkable that the pump was working well and the cannula was not changed. After the ketosis was resolved, she continued using the same cannula with good metabolic control. Conclusion: Euglycemic ketosis is a life-threatening condition that must be suspected.

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“…[5][6][7][8][9][10] Use of SGLT2 inhibitors was associated with improvements in average glucose control, reduced postprandial hyperglycemia and glycemic variability, reduced body weight, and reduced insulin dose requirements. [11][12][13] Dual SGLT1/2 inhibitor, sotagliflozin, has also demonstrated significant reductions in HbA1c, postprandial glucose, weight, and insulin doses.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Ketoacidosis in a Patient with Type 1 Diabetes on Sodium-glucose Co-transporter-2 Inhibitors—a Case Report

Priya¹,

Bhambri²

2017

US Endocrinology

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W e describe a case of a 26-year-old female with long-standing type 1 diabetes (T1D), on multiple subcutaneous insulin injections, who had been taking empagliflozin for the past year. She was detected to have severe diabetic ketoacidosis (DKA) with relatively lower blood glucose values during hospitalisation for dengue fever. The factors that precipitated the DKA are discussed, along with the unique challenges in the management of her metabolic status. While sodium-glucose co-transporter-2 (SGLT2) inhibitors have several potential benefits as adjunctive add-on therapy to insulin in T1D, the evidence is limited to short-term studies. However, their off-label use is increasing and there have been concerns related to increased risk of diabetic ketoacidosis. At present, SGLT2 inhibitors are not approved for use in T1D, and the risks should be discussed at length with the patient. KeywordsType 1 diabetes, diabetic ketoacidosis, euglycaemic diabetic ketoacidosis, sodium-glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin Disclosure: Gagan Priya and Vishal Bhambri have nothing to declare in relation to this article. No funding was received in the publication of this article.Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this case study.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. We report a case of diabetic ketoacidosis in a 26-year-old female with long-standing type 1 diabetes (T1D) who was on multiple subcutaneous insulin injections and empagliflozin. Informed consent was taken from the patient for the publication of this report. Case reportA 26-year-old female, a postgraduate student, with long-standing T1D since the age of 10 presented to the emergency department on the evening of July 2017 with a history of fever for 4 days and a petechial rash over the trunk and upper arms for 2 days. She complained of malaise and loss of appetite but there was no history of rigors or chills, dysuria, diarrhea, vomiting, abdominal discomfort or respiratory difficulty. At presentation, she was conscious and well-oriented and had a fever (temperature 99.8°F), her vitals were stable and she had no hypotension. She had a petechial rash on the upper body and an extensive genital and inguinal mycotic infection, but the rest of the systemic examination was otherwise normal.For her diabetes, she had been taking multiple subcutaneous insulin injections for severa...

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Dapagliflozin as an adjunct therapy to insulin in the treatment of patients with type 1 diabetes mellitus

Cited by 31 publications

References 16 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

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso

Diabetic Ketoacidosis in a Patient with Type 1 Diabetes on Sodium-glucose Co-transporter-2 Inhibitors—a Case Report

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