SGLT-2 inhibitors as adjunctive to insulin therapy in type 1 diabetes

Abstract

The absolute insulin deficiency that occurs in type 1 diabetes mellitus (T1DM) is associated with the need for intensive functional insulin therapy as the only appropriate treatment model. In the recent years, introduction of new classes of glucose-lowering drugs has led to an increasing interest in adjunct therapies for T1DM. These therapies are designed to support exogenous insulin therapy in achieving the therapeutic goal while reducing the risk of hypoglycaemia and exerting a beneficial effect on body weight. One potential therapeutic option are sodium-glucose co-transporter 2 (SGLT-2) inhibitors. In the present paper, we reviewed the current clinical research on SGLT-2 inhibitors as add-on therapy to insulin in patients with T1DM. This therapy modification contributes to an improvement in metabolic control without increasing the risk of severe hypoglycaemia and with a beneficial effect on body weight, translating to improved compliance, quality of life, and patient satisfaction with treatment. However, due to possible adverse effects including euglycaemic diabetic ketoacidosis, the decision to use SGLT-2 inhibitors in patients with T1DM should be made with caution, and patients require proper education regarding the prevention and treatment of acidosis.

Pacjent żywiony parenteralnie – problem z insulinoterapią i nie tylko.

“…Other drugs that might be beneficial are sodium-glucose cotransporter 2 (SGLT2) inhibitors due to their additional diuretic effect in patients with volume overload induced by parenteral nutrition. Currently, SGLT2 inhibitors may also be used in patients with diabetes type 1 in some clinical settings, and even in patients with heart failure without concomitant diabetes [13,14]. For these reasons, a proper diagnosis of diabetes is the basis for selecting appropriate treatment in patients after intestinal resection.…”

Adjuvant therapy in type 1 diabetes mellitus

“…In addition to absolute insulin deficiency, an increasing number of patients experience a whole spectrum of metabolic syndrome-related disorders, including obesity and paradoxically insulin resistance [1]. Currently, functional insulin therapy is the cornerstone of the treatment of T1DM, but adjuvant therapies are used more commonly, such as metformin [2][3], SGLT2 inhibitors [4][5], and GLP-1 analogues [6]. In conclusion, in addition to insulin, the number of therapeutic options is increasing for patients with T1DM, especially for those with concomitant obesity and metabolic syndrome.…”

Zastosowanie dapagliflozyny w terapii cukrzycy typu 1 u 36-letniej kobiety - opis przypadku

“…As the SGLT-2 cotransporter is responsible for nearly 90% of glucose reabsorption, it leads to decrease in glucose blood concentration and subsequent weight loss [5]. Additionally, flozins increase diuresis and lower the blood pressure [6].…”

“…The most common adverse effects of dapagliflozin are: urinary tract infections, euglycemic ketoacidosis and, when used simultaneously with insulin, hypoglycaemia [6,9].…”