Combined treatment with SGLT2 inhibitors and insulin is a viable option for treating patients with type 1 diabetes, according to results from a systematic review and meta-analysis.
“Sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a relatively new class of antidiabetic agents with unique mechanisms of action,” Dana El Masri, PharmD, of the Wayne State University School of Medicine, Detroit, and colleagues wrote. “Currently in the U.S., the FDA has approved three drugs in this class for patients with type 2 diabetes: dapagliflozin, canagliflozin and empagliflozin. However, there is insufficient data to recommend their use in patients with type 1 diabetes.”
El Masri and colleagues performed a systematic review and meta-analysis of four randomized controlled trials of therapy with SGLT2 inhibitors for type 1 diabetes; studies were identified using the PubMed, Embase, Scopus, Web of Science and Cochrane databases and had been published through August 2017. The researchers extracted data on patients’ HbA1c, total daily insulin dose, body weight and reported adverse events.
SGLT2 inhibitors lowered HbA1c compared with placebo, the researchers reported (weighted mean difference, 0.39; 95% CI, 0.27-0.51). Further, therapy with SGLT2 inhibitors led to lower daily doses of insulin (weighted mean difference, 5.03; 95% CI, 1.83-8.23) and lower body weight compared with placebo (weighted mean difference, 2.76; 95% CI, 1.11-4.4).
Patients assigned to SGLT2 inhibitors did not show significantly different rates of adverse events compared with those assigned to placebo, El Masri and colleagues wrote.
The researchers acknowledged that the study was limited by its small sample size, not just because the meta-analysis included only four trials, but also because three of the four trials included fewer than 100 patients. Furthermore, the studies included in the analysis used varying lengths of treatment, including two that ran for less than 12 weeks.
“Limited data suggest a role for SGLT2 inhibitors for patients with type 1 diabetes, and their unique mechanism of action signifies a promising new therapy for this patient population,” El Masri and colleagues wrote. “The current meta-analysis suggests the safety and efficacy of SGLT2 inhibitors in patients with type 1 diabetes. However, additional prospective [randomized controlled trials] of larger sample sizes and longer duration are needed to further assess the role of SGLT2 inhibitors in the treatment of type 1 diabetes.”
Disclosures: The authors report no relevant financial disclosures.