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Sodium-glucose co-transporter-2 inhibitors in type 1 diabetes : a scoping review
ID Hropot, Tim (Author), ID Battelino, Tadej (Author), ID Dovč, Klemen (Author)

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Abstract
Background: With recent developments in diabetes technology, attaining adequate glucose control is more achievable than ever. Despite these improvements, a significant proportion of individuals with type 1 diabetes do not reach recommended glycaemic goals. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are glucose-lowering agents that inhibit the reabsorption of filtered glucose in the kidneys, thus promoting glucosuria. Because the glucose-lowering effect of SGLT2 inhibitors is achieved independently of insulin secretion, it has been speculated whether they could bridge the gap towards achieving glycaemic targets in individuals with type 1 diabetes. Summary: Our main goal was to systematically map the current knowledge on the efficacy and safety of SGLT2 inhibitor use in adults with type 1 diabetes and present recent studies regarding the use of SGLT2 inhibitors in youth with type 1 diabetes. Using a scoping review approach, we searched MEDLINE to identify relevant clinical trials of SGLT2 inhibitors as adjunctive therapy to insulin in type 1 diabetes published from January 31, 2012, to January 31, 2022. We included the most relevant, large-scale, and long placebo-controlled clinical trials of SGLT2 inhibitors as an add-on therapy to insulin in adults with type 1 diabetes. Additionally, we included all relevant pilot studies evaluating the use of SGLT2 inhibitors as add-on therapy to insulin in youth with type 1 diabetes. We identified eight placebo-controlled clinical trials in adults with type 1 diabetes meeting our inclusion criteria and two relevant pilot studies in youth with type 1 diabetes. The clinical trials in adults with type 1 diabetes confirmed the efficacy of SGLT2 inhibitors as add-on therapy to insulin. However, this was associated with an increased incidence of diabetic ketoacidosis (DKA) versus placebo in all identified clinical trials. The two relevant pilot studies in youth with type 1 diabetes showed promising results of SGLT2 inhibitor use as an add-on therapy to insulin, especially when combined with a fully closed-loop system. Key Messages: SGLT2 inhibitors, as an add-on therapy to insulin, improve glycaemic outcomes in adults with type 1 diabetes with a potential cost of increasing DKA risk. The use of add-on SGLT2 inhibitors to insulin shows promising results in youth with type 1 diabetes. Moreover, SGLT2 inhibitors as add-on therapy in combination with closed-loop insulin therapy could provide additional benefits in improving glycaemic control. The current role of SGLT2 inhibitors as an adjunct therapy to insulin in individuals with type 1 diabetes is yet to be determined.

Language:English
Keywords:type 1 diabetes, SGLT2 inhibitors, diabetic ketoacidosis, closed-loop system
Work type:Article
Typology:1.02 - Review Article
Organization:MF - Faculty of Medicine
Publication status:Published
Publication version:Version of Record
Year:2023
Number of pages:Str. 620–630
Numbering:Vol. 96, iss. 6
PID:20.500.12556/RUL-155111 This link opens in a new window
UDC:616.379
ISSN on article:1663-2826
DOI:10.1159/000527653 This link opens in a new window
COBISS.SI-ID:137191427 This link opens in a new window
Publication date in RUL:20.03.2024
Views:617
Downloads:189
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Record is a part of a journal

Title:Hormone research in paediatrics
Shortened title:Horm. res. paediatr.
Publisher:S. Karger
ISSN:1663-2826
COBISS.SI-ID:518820633 This link opens in a new window

Licences

License:CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
Link:http://creativecommons.org/licenses/by-nc/4.0/
Description:A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

Language:Slovenian
Keywords:pediatrija, sladkorna bolezen tipa 1, kontrola glukoze

Projects

Funder:ARRS - Slovenian Research Agency
Project number:J3-6798
Name:Biološki, genetski in epigenetski označevalci debelosti in metabolnega sindroma pri otrocih in mladostnikih

Funder:ARRS - Slovenian Research Agency
Project number:V3-1505
Name:Analiza in razvoj področja redkih bolezni v Sloveniji

Funder:ARRS - Slovenian Research Agency
Project number:P3-0343
Name:Etiologija, zgodnje odkrivanje in zdravljenje bolezni pri otrocih in mladostnikih

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