Over the past couple of years, several new drugs have become available to treat diabetes, specifically type 2. Some that lower appetite, slow down digestion and absorption of carbohydrates, increase insulin production, modify expression of certain genes involved in sugar metabolism, or even increase the amount of sugar the body excretes in the urine.
Can these drugs be used in type 1 diabetes (T1D)? Not yet. But some are being studied. One type of medication that has been garnering most of the attention are Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors. These pills allow more sugar to leave the body through urine. They work by blocking a ‘transporter’ in the kidneys called SGLT-2 that normally helps the body recover sugar.
SGLT-2 inhibitors in T2D?
In T2D SGLT-2 inhibitors were found to be associated with the following:
- Better blood sugar levels: meaning lower overall levels AND less hypoglycemia
- Weight loss
- Less heart disease development
- Less kidney disease development
- Lower blood pressure
- More yeast infections (genital, vaginal)
- Higher susceptibility to fractures
Additionally they also reported higher risk of diabetic ketoacidosis. Which usually happens in T1D but not in T2D. When it happens in someone not taking SGLT-2 inhibitors, the person has a really high blood sugars, is dehydrated, may be confused, and has high acid levels in the blood. However, if the person is on these new drugs, the sugars may not be high but the person will show the other signs. (1)
Can SGLT-2 inhibitors be used for better blood sugar management in T1D?
SGLT-2 inhibitors are being evaluated for use by people with T1D by the Food and Drug Administration in the USA. They are not yet approved by Health Canada for people with T1D.
A new study followed a group of almost 1600 persons living with T1D who had high HbA1c (between 7.7 and 11.0%). They had their blood sugar assessed continuously for 24 weeks. The participants were either given an SGLT-2 inhibitor (dapagliflozin) or a placebo. Those who got the inhibitor spent more time in the target blood glucose range at 24 weeks into the study and they didn’t have more lows.(2)
Another group looked at different studies with sotagliflozin in people with T1D. They looked at results from more than 3,000 people. Some of the studies were as short as 4 weeks while others were as long as 52 weeks. Overall. Blood glucose was better controlled: lower A1C, lower fasting sugars, lower sugars after meals, and less hypoglycemia. Body weight also went down as well as the amount of insulin taken. However, there was more ketoacidosis and more genital tract infections. (3)
Bottom line
These drugs are not officially ready for use in type 1 diabetes. We need more evidence, more discussion, and more recommendations. Stay tuned and talk to your health care team if you have questions.
References:
- Lipscombe L, Booth G, Butalia S, et al. Pharmacologic glycemic management of type 2 diabetes in adults. Canadian journal of diabetes. 2018;42(5):103. doi:10.1016/j.jcjd.2018.08.195
- Mathieu C, Dandona P, Phillip M, et al. Glucose variables in type 1 diabetes studies with dapagliflozin: pooled analysis of continuous glucose monitoring data from depict-1 and -2. Diabetes care. 2019;42(6):1081-1087. doi:10.2337/dc18-1983
- Musso G, Gambino R, Cassader M, Paschetta E. Efficacy and safety of dual sglt 1/2 inhibitor sotagliflozin in type 1 diabetes: meta-analysis of randomised controlled trials. Bmj. 2019;365. doi:10.1136/bmj.l1328Musso G, Gambino R, Cassader M, Paschetta E. Efficacy and safety of dual sglt 1/2 inhibitor sotagliflozin in type 1 diabetes: meta-analysis of randomised controlled trials. Bmj. 2019;365. doi:10.1136/bmj.l1328