Use of SGLT-2 Inhibitors in Patients with Type 1 Diabetes Mellitus
El Hage, L1; Kashyap, S1; Rao, P1
1Endocrinology & Metabolism Institute, Cleveland Clinic Foundation - Cleveland, OH

Introduction:
Sodium – glucose cotransporter 2 (SGLT – 2) inhibitors are the newest class of oral anti-hyperglycemic medications approved for the treatment of type 2 diabetes (DM2). They block SGLT -2 transporters in the kidney and inhibit glucose reabsorption from the renal tubules. Current studies have shown significant improvement in glycemic control, cardiovascular outcomes, and metabolic parameters in patients with type 2 diabetes [1-6]. Although they are not approved for use in type 1 diabetes (DM1), SGLT2 inhibitors may improve glycemic control, decrease …show more content…
Twenty out of the twenty six patients showed improvement in their HbA1c, one patient did not show any change, while five had worsening of their glycemic control. Of those that had worsening in their glycemic control, three were on insulin pump therapy, two were treated with empagliflozin and the rest with canagliflozin. The characteristic of these patients is shown in table 2. HbA1c improved to 7.9% (SD 1.2) with a decrease of 0.32% (p=0.032) with therapy. Improvement in glycemic control was seen as early as one month post therapy and was maintained with continued SGLT-2 inhibitor use. There was a slight increase in LDL level with therapy, from mean of 93 mg/dl (SD 29) to 98 mg/dl (SD 32); p=0.049. No significant changes were seen with respect to weight (p=0.518), systolic BP (p=0.95), diastolic BP (p=0.273), triglycerides (p=0.84), HDL (p=0.094) or cholesterol (p=0.60). Changes in the metabolic profile are shown table 3. There was a non-significant weak negative correlation between HbA1c change and duration of SGLT-2 inhibitor therapy (rho -0.2, p=0.35) indicating that the change in HbA1c may not be solely associated with the latter; limitation may be due to low power to detect …show more content…
The improvement seen was less than that reported in literature for DM 2 patients were rates ranged between 0.5 – 1.05% based on dose and type of SGLT-2 inhibitor used. Reduction in weight reported in literature has ranged between 1.2 – 2.37 kg, again based on the dose and type of SGLT-2 inhibitor medication used [8]. The mechanism for weight loss appears to be secondary to glycosuria and alteration in fat metabolism [9]. There continues to be ongoing studies looking at the mechanism of weight loss induction by these medications, including the use of combined GLP-1 agonist therapy to help maximize weight loss by suppressing the increased appetite seen with SGLT-2 inhibitor therapy. Although our study showed a downward trend in weight in our patients (mean decrease of 0.5 kg), it was not statistically