SGLT inhibitors boost glycaemic control in T1D but carry side effects

Sodium-glucose co-transporters (SGLT) 2 and 1/2 inhibitors help improve glycaemic control in patients with type 1 diabetes (T1D), reports a new meta-analysis.

Drawing from the databases of the Cochrane Library, CNKI, Wan Fang, PubMed, and Embase, researchers retrieved 13 randomized controlled trials (RCTs), all of which compared SGLT inhibitors to placebo under background insulin treatment.

Five studies assessed fasting plasma glucose (FPG), with no strong heterogeneity among them. Pooled analysis revealed a significant effect of SGLT inhibitors on FPG relative to placebo (weighted mean difference [WMD], –1.320, 95 percent confidence interval [CI], –1.609 to –1.031; p<0.001). This remained true for both SLGLT 2 and 1/2 inhibitors.

SGLT inhibitors likewise improved glycaemic control as assessed by the mean amplitude of glucose excursion (WMD, –18.745; 95 percent CI, –23.289 to –14.192; p<0.001) and by glycated haemoglobin (HbA1c; WMD, –0.386, 95 percent CI, –0.431 to –0.345; p<0.001). SGLT2 and dual SGLT inhibitors likewise led to significant improvements in HbA1c.

SGLT inhibitors also led to reductions in the daily total, bolus, and basal insulin doses.

Notably, these improvements came with some safety concerns. Those who were taking SGLT2 inhibitors, for example, were 330-percent more likely to develop diabetic ketoacidosis than controls (p=0.001). Patients on the dual SGLT 1/2 inhibitors saw a 580-percent jump in risk (p<0.001).

SGLT inhibitors also increased the likelihood of genital and urinary tract infections and diarrhoea, without carrying additional risk for hypoglycaemia.

“Aiming to provide more solid evidence concerning the use of SGLT inhibitors for the treatment of T1D, larger-scale clinical trials are needed to further investigate the therapeutic value of SGLT 2 inhibitors, dual SGLT 1/2 inhibitors and even SGLT 1 inhibitors in patients with T1D,” researchers said.