<p>Empagliflozin in type 1 diabetes</p>

Abstract

There is a clear unmet need in people living with type 1 diabetes (T1D). Although the quality of life of people with T1D has improved, issues like hypoglycemia, weight gain and variability in glucose profiles remain. In this review, the clinical efficacy and safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor in T1D, is described based on a review of phase 2 and 3 studies to date. Empagliflozin and SGLT2 inhibitors, in general, are effective glucose-lowering drugs, which also work in people with T1D. Recent phase II and III studies, including the EASE trials for empagliflozin, showed a clear beneficial effect on HbA1c, body weight, glucose variability and total daily insulin use in people with T1D. No increase in hypoglycemia risk, in particular severe hypoglycemia, was observed, but genital infections were more prevalent. The use of SGLT2 inhibitors comes with a decrease in insulin doses, making individuals more prone to diabetic ketoacidosis (DKA). The uniqueness of the EASE program is that here, a very low dose of empagliflozin was used, with less, but still present, effects on metabolic outcomes, but interestingly a lower risk of DKA. Importantly, even in the higher doses of empagliflozin, it is clear that the overall risk for DKA remains low, most likely by educating patients and caretakers intensively on this subject. In conclusion, evidence is building on the potential of using empagliflozin, like other SGLT2 inhibitors, in T1D. However, to date, the use of empagliflozin is not approved in people with T1D. Clinicians will have to weigh the potential short- and long-term benefits of these adjunct therapies versus the potential acute side effects, in particular, the small but real risk of DKA in the individual T1D patient.

Cardiovascular effects and mechanisms of sodium‐glucose cotransporter‐2 inhibitors

“… 32 , 33 In type 1 diabetes, it has been reported that empagliflozin reduced arterial stiffness. 34 Presumably, this reduction is related to the improved arterial compliance and weight loss. In T2D, empagliflozin has been shown to improve arterial stiffness and vascular resistance.…”

Excitation spectrum and density matrix renormalization group iterations

“…The critical Ising model is described in the context of CFT by the minimal model defined by (p, p ) = (4, 3) 17,18 . A brief review of the general properties of the minimal models is included in Appendix A.…”

“…The model is critical and integrable for h = J. The critical theory is again described by a mininimal model of CFT with (p, p ) = (6, 5) 18,23,24 . Its central charge is given by c = 4/5.…”

“…A minimal model is unitary if and only if |p − p| = 1 18,39 . In that case, the minimal conformal dimension is h 1,1 = 0 and it corresponds to the identity primary conformal field φ (1,1) = I.…”

“…The first non-trivial (c > 0) unitary model is labeled by (4, 3) and corresponds to the critical Ising model in a transverse field 17,18 . The following pairs (5,4) and (6,5) label the tri-critical Ising model 18,40 and the three-state Potts model 18,23,24 respectively. One of the fundamental characteristics of a conformal field theory is its central charge, as first realized in Ref.…”