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In part 8, the conclusion of this Exclusive Interview, John Buse talks with Diabetes in Control Publisher Steve Freed about the good and bad effects of using SGLT2 for patients who have type 1.
John Buse, PhD, MD, is professor, chief of the Division of Endocrinology, and director of the Diabetes Center at the University of North Carolina at Chapel Hill School of Medicine.
Transcript of this video segment:
Freed: Although it hasn’t been approved, what about type 1s and the SGLT-2s?
Buse: So, there are a huge number of presentations here at the ADA on the use of SGLT-2 Inhibitors in type 1 diabetes and the main issue seems to be an increased risk of diabetic ketoacidosis. So, the SGLT-2 Inhibitors have efficacy in reducing hemoglobin A1C by about half a percent, body weight by up to 5% over a year, so a big benefit in weight, improvements in blood pressure, reductions in rates of hypoglycemia, at the same time you’re reducing average glucose, improved time and range, less glycemic variability, improved so-called patient reported outcomes. Patients just feel better on these drugs. So, all of that is very exciting but 3% or 4% per year additional risk of diabetic ketoacidosis. So, the regulators are going to have to think hard about this. I think in patients who are very careful in their self-care behaviors, very attentive to what’s going on in their body, I believe that in such a patient with type 1 diabetes, as long as they remember to check their ketones whenever they feel unwell, whether it’s a little bit of nausea or just like, “I don’t have any energy today.” Low level ketoacidosis is hard to sort out. But in general, those patients would have mild symptoms that would give them a hint, that they have ketones that really just needs to be treated with food, with carbohydrates, and insulin, So, it’s not like the treatment is so hard if it’s detected early. The problem is if you don’t catch diabetic ketoacidosis early people could end up in the intensive care unit.
Freed: Type 1s, because we’ve seen they do use SGLT-2s, so there’s a reduction in hypoglycemia and it’s due to the effect because my personal experience has been that they’re using a lot less insulin with the SGLT-2s, which means we can have less hypo just by virtually using less insulin.
Buse: Right. So, it is associated with the reduction in the insulin use. But by nature the SGLT-2 Inhibitors they work harder, they work better when the glucose level is high and they have less effect when the glucose level is low. So, by nature they tend to have sort of a buffering capacity where it does reduce glycemic variation.