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Potential of SGLT2 Inhibitors in Type 1 Diabetes

Pilot study shows that an SGLT-2 inhibitor doses of 5-mg and 10-mg were associated with significant reductions in blood glucose and total daily insulin dose….
Dapagliflozin is a member of the SGLT2 inhibitor class of diabetic medications indicated only for treatment of type 2 diabetes. Dapagliflozin helps reduce blood glucose by inhibiting glucose reabsorption without depending on the insulin and by increasing glycosuria.

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An exploratory pilot study suggests that dapagliflozin may have potential as an add-on therapy for treating type 1 diabetes. It was a 2-week randomized, double blinded, placebo-controlled study. The 70 patients, with mean age of 35 years and baseline HbA1c of 8.5%, with type 1 diabetes were randomized to either daily dapagliflozin doses of 1, 2.5, 5, or 10 mg or to placebo. Only 62 patients completed the study. The primary outcome was to assess short-term safety and secondary outcome was to look at pharmacokinetics, pharmacodynamics, and efficacy parameters.
Glucosuria was increased by 88g/24 h (95% CI 55-121) with administration of dapagliflozin 10 mg compared to reduction of -21.5g/24 h (95% CI −53.9 to 11.0) with placebo. By day 7, the changes from baseline with administration of dapagliflozin 10 mg for 24-hour daily average blood glucose level was -2.29 mmol/d (95% CI -3.71 to -0.87), for mean amplitude of glycemic excursion was −3.77 mmol/L (95% CI −6.09 to −1.45), and for mean % change in total daily insulin dose was −16.2% (95% CI −29.4 to −0.5), and for the mean % change in total daily insulin dose (−16.2% (95% CI −29.4 to −0.5).
Overall, this data result suggests that dapagliflozin in adults with type 1 diabetes showed expected pharmacokinetic profile with acceptable short-term tolerability and increase in urinary glucose excretion. More long-term studies with large population count should be conducted to attain more precise results.
Practice Pearls:
  • Dapagliflozin, SGLT2 inhibitor, may have potential as an add-on therapy for patients with type 1 diabetes.
  • This study data shows that dapagliflozin demonstrated decrease in blood glucose levels and also decrease in insulin dose when used as add-on therapy.
  • Further long-term study to be conducted with larger population to get more precise results about the drug.
Henry, Robert. “Exploring the Potential of the SGLT2 Inhibitor Dapagliflozin in Type 1 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.” Diabetes Care, September 30, 2014, doi: 10.2337/dc13-2955.