Letter from the Editor, #783

Last week in our SGLT- Inhibitor Special Edition for May, we discussed the idea of early adopters using the complete arsenal of diabetes medications for both type 1 and type 2 patients. When I mentioned that one of our advisory board members, Dr. Stanley Schwartz, sets a high bar in using all the medication in the diabetes armada for his patients, another of our board members shared his experience. Dr. Paul Chous has had type 1 diabetes for 47 years and shared this with me:

My A1c value in January 2015 was 7.1%. I have been on insulin pump therapy with CGMS x 10 years (now Animas + Dexcom G4 Platinum).

My endo retired last Fall and I asked my new endocrinologist about trying an SGLT2 inhibitor — he agreed I could try and so I started Farxiga 5 mg.

I immediately noted dramatic reduction in glycemic variability. At week 10, I had lost 12 lbs. Yesterday, my A1c was 5.8%, my time less than 60 mg/dl was <1% and my mean glucose std dev was 27 mg/dl, down from 87 mg/dl. All this was achieved with no change in diet or exercise over 4 months; significantly, on only 1 occasion has my spot glucose surpassed 200 in that time period.

Adding the SGLT2-I to my regimen has been the single most beneficial change to my diabetes management EVER, far surpassing the benefit of pumping insulin. I have simply been ‘blown away’ by the benefit I have sustained to date.

This lends more evidence that this class can be used in insulin-using patients and if you look at Item #11 the results of the CANagliflozin CardioVascular Assessment Study also make a case for using the SGLT-2 inhibitors on type 2 patients on insulin.

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