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Qiang W, Yang F, Liu L, Dong R, Sun Y, Mondal A, Guo H. SGLT-2 inhibitors and high-dose acarbose as potential high-risk combinations for ketosis and ketoacidosis in Asian patients with T2DM: A case series. Clin Case Rep 2024; 12:e9282. [PMID: 39267955 PMCID: PMC11390491 DOI: 10.1002/ccr3.9282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 09/15/2024] Open
Abstract
Key Clinical Message High-dose acarbose may increase the risk of diabetic ketosis/diabetic ketoacidosis in Asian patients on sodium-glucose cotransporter-2 inhibitors. Healthcare providers and patients should be cautious to avoid this combination. Abstract Low-calorie diets should be avoided in patients receiving sodium-glucose cotransporter-2 (SGLT-2) inhibitors to decrease the risk of diabetic ketoacidosis (DKA). High-dose acarbose can decelerate carbohydrate absorption. We detail three cases of diabetic ketosis (DK) following concurrent SGLT-2 inhibitor and high-dose acarbose therapy (acarbose 300 mg/day and dapagliflozin 10 mg/day). Patients, aged 38-63 years with 3-10 years of type 2 diabetes mellitus (T2DM), developed DK, indicated by moderate urinary ketones and high glucose (urine ketone 2+ to 3+ and glucose 3+ to 4+) without acidosis, within 4 days to 1 month post-therapy initiation. Serum glucose was 172.8-253.8 mg/dL; HbA1c was 9.97%-10.80%. The combination therapy was halted, and DK was managed with low-dose intravenous insulin and fluids, followed by intensive insulin therapy. High-dose acarbose with SGLT-2 inhibitors may increase the risk of DK/DKA in Asian patients.
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Affiliation(s)
- Wei Qiang
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
| | - Fei Yang
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
- Department of Endocrinology The First Affiliated Hospital of Xi'an Medical University Xi'an P. R. China
| | - Ling Liu
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
- Department of Endocrinology Chang Qing Oil Field Worker's Hospital Xi'an P. R. China
| | - Ruiqing Dong
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
| | - Yushi Sun
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
| | - Ahona Mondal
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
| | - Hui Guo
- Department of Endocrinology and Metabolism The First Affiliated Hospital of Xi'an Jiaotong University Xi'an P. R. China
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Khan P, Venkatesh S, Parveen R, Mishra P, Jain S, Agarwal N. Longitudinal efficacy of Ertugliflozin in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Expert Opin Pharmacother 2023; 24:2199-2210. [PMID: 37955156 DOI: 10.1080/14656566.2023.2279100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Ertugliflozin, a sodium-glucose cotransporter-2 inhibitor, seems to improve glycemic control in type 2 diabetes mellitus (T2DM). We aim to evaluate the efficacy of Ertugliflozin across multiple time intervals (18, 26, and 52 weeks) in T2DM patients. METHODS A literature search was conducted on electronic databases. Data was extracted from eligible studies at both 5 mg and 15 mg doses in monotherapy and as add-on therapy. Cochrane RevMan was used to perform the meta-analysis. RESULTS Ertugliflozin, at both 5 mg and 15 mg doses, demonstrated a significant improvement in HbA1c levels at 18 weeks 5 mg [P = 0.00001], 15 mg [P = 0.05], and at 26 weeks in monotherapy 5 mg [P = 0.006], monotherapy 15 mg [P = 0.006], 5 mg as add-on therapy [P = 0.00001], 15 mg add-on therapy [P = 0.00001] respectively. At 52 weeks, the reduction in HbA1c was significant in 15 mg add-on therapy [P = 0.0001]. Additionally, ertugliflozin as an add-on therapy also led to a significant reduction in FPG, body weight, and systolic blood pressure. CONCLUSION Ertugliflozin showed clinical efficacy in improving glycemic control, fasting plasma glucose, body weight, and systolic blood pressure in T2DM patients over the studied time intervals compared to placebo.
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Affiliation(s)
- Parvej Khan
- Department for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | | | - Rizwana Parveen
- Department for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Pinki Mishra
- Department for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Seema Jain
- Department of Pharmacology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Nidhi Agarwal
- Department for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
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Vidigal AC, de Lucena DD, Beyerstedt S, Rangel ÉB. A comprehensive update of the metabolic and toxicological considerations for immunosuppressive drugs used during pancreas transplantation. Expert Opin Drug Metab Toxicol 2023; 19:405-427. [PMID: 37542452 DOI: 10.1080/17425255.2023.2243808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Despite significant advancements in immunosuppressive regimens and surgical techniques, the prevalence of adverse events related to immunosuppression remains a major challenge affecting the long-term survival rates of pancreas and kidney allografts. AREAS COVERED This article presents a comprehensive review of the literature and knowledge (Jan/2012-Feb/2023) concerning glucose metabolism disorders and nephrotoxicity associated with tacrolimus and mammalian target of rapamycin inhibitors (mTORi). Novel signaling pathways potentially implicated in these adverse events are discussed. Furthermore, we extensively examine the findings from clinical trials evaluating the efficacy and safety of tacrolimus, mTORi, and steroid minimization. EXPERT OPINION Tacrolimus-based regimens continue to be the standard treatment following pancreas transplants. However, prolonged use of tacrolimus and mTORi may lead to hyperglycemia and nephrotoxicity. Understanding and interpreting experimental data, particularly concerning novel signaling pathways beyond calcineurin-NFAT and mTOR pathways, can offer valuable insights for therapeutic interventions to mitigate hyperglycemia and nephrotoxicity. Additionally, critically analyzing clinical trial results can identify opportunities for personalized safety-based approaches to minimize side effects. It is imperative to conduct randomized-controlled studies to assess the impact of mTORi use and steroid-free protocols on pancreatic allograft survival. Such studies will aid in tailoring treatment strategies for improved transplant outcomes.
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Affiliation(s)
- Ana Cláudia Vidigal
- Nephrology Division, Department of Medicine, Federal University of São Paulo, SP, Brazil
| | - Débora D de Lucena
- Nephrology Division, Department of Medicine, Federal University of São Paulo, SP, Brazil
| | - Stephany Beyerstedt
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, SP, São Paulo, Brazil
| | - Érika B Rangel
- Nephrology Division, Department of Medicine, Federal University of São Paulo, SP, Brazil
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, SP, São Paulo, Brazil
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Saha S, Saha S, Gayen M. Treatment-duration-wise harm profile of insulin-sodium-glucose co-transporter inhibitor co-treatment in type 1 diabetes mellitus patients. J Diabetes Metab Disord 2023; 22:673-701. [PMID: 37255836 PMCID: PMC10225433 DOI: 10.1007/s40200-023-01192-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/26/2023] [Indexed: 06/01/2023]
Abstract
Background The treatment duration of insulin-sodium-glucose co-transporter inhibitors (SGLTis) co-treatment of type 1 diabetes mellitus (T1DM) patients in randomized controlled trials (RCTs) varies by 1-52 weeks. Henceforth, treatment duration-wise, we compared the following insulin-treatment adjuncts- mega- versus low-dose SGLTis, SGLTis versus placebo, and different SGLTi dosages. Method Double-blinded RCTs reporting the above were searched (using terms like insulin-dependent, "juvenile-onset diabetes," and "sodium glucose cotransport*") in the PubMed, Embase, and Scopus databases and appraised using a Cochrane tool. The risks across different SGLTi-dosages were compared using network meta-analysis. Random-effect pairwise meta-analysis was performed for the remaining harm juxtapositions. Meta-analyses were performed for the following treatment durations- < 4 weeks, 4 to < 24 weeks, and ≥ 24 weeks. For meta-analysis and certainty of evidence assessment, we used the Stata statistical software and the GRADE method, respectively. Results A total of 15 (low risks of bias) studies sourcing data from about 7,330 T1DM patients were reviewed. Meta-analysis findings of ≥ 24 weeks long trials were- a. SGLTi-insulin co-treatment increased the genital infection (GI) (RR: 3.51; 95% CI: 2.59, 4.77), diabetic ketoacidosis (DKA) and (RR: 3.25; 95% CI:1.29, 8.16), and serious side effects (RR: 1.43; 95% CI: 1.05, 1.94) risk. b. SGLT2i-insulin increased the GI risk (RR: 3.77; 95% CI: 2.31, 6.16; high-quality evidence). c. Sotagliflozin-insulin increased the GI (RR: 3.36; 95% CI: 2.28, 4.96) and DKA (RR: 6.69; 95% CI: 2.75, 16.32) risk (both high-quality evidence). Compared to low-dose, megadose SGLTi treatment for 4 to < 24 weeks increased the GI risk. The remaining analyses were not statistically significantly different. Conclusion On moderate to long-term treatment (24-52 weeks) of T1DM patients, insulin-SGLT2i co-treatment was associated with GI risk, and insulin-sotagliflozin co-treatment was associated with DKA and GI risk. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01192-7.
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Affiliation(s)
- Sumanta Saha
- Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal India
| | - Sujata Saha
- Department of Mathematics, Mankar College, Mankar, West Bengal India
| | - Mohan Gayen
- Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal India
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Boeder SC, Gregory JM, Giovannetti ER, Pettus JH. SGLT2 Inhibition Increases Fasting Glucagon but Does Not Restore the Counterregulatory Hormone Response to Hypoglycemia in Participants With Type 1 Diabetes. Diabetes 2022; 71:511-519. [PMID: 34857545 PMCID: PMC8893946 DOI: 10.2337/db21-0769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022]
Abstract
Individuals with type 1 diabetes have an impaired glucagon counterregulatory response to hypoglycemia. Sodium-glucose cotransporter (SGLT) inhibitors increase glucagon concentrations. We evaluated whether SGLT inhibition restores the glucagon counterregulatory hormone response to hypoglycemia. Adults with type 1 diabetes (n = 22) were treated with the SGLT2 inhibitor dapagliflozin (5 mg daily) or placebo for 4 weeks in a randomized, double-blind, crossover study. After each treatment phase, participants underwent a hyperinsulinemic-hypoglycemic clamp. Basal glucagon concentrations were 32% higher following dapagliflozin versus placebo, with a median within-participant difference of 2.75 pg/mL (95% CI 1.38-12.6). However, increased basal glucagon levels did not correlate with decreased rates of hypoglycemia and thus do not appear to be protective in avoiding hypoglycemia. During hypoglycemic clamp, SGLT2 inhibition did not change counterregulatory hormone concentrations, time to recovery from hypoglycemia, hypoglycemia symptoms, or cognitive function. Thus, despite raising basal glucagon concentrations, SGLT inhibitor treatment did not restore the impaired glucagon response to hypoglycemia. We propose that clinical reduction in hypoglycemia associated with these agents is a result of changes in diabetes care (e.g., lower insulin doses or improved glycemic variability) as opposed to a direct, physiologic effect of these medications on α-cell function.
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Affiliation(s)
- Schafer C. Boeder
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
- Corresponding author: Schafer C. Boeder,
| | - Justin M. Gregory
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Erin R. Giovannetti
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Jeremy H. Pettus
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
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Li Y, Li H, Dong L, Lin D, Xu L, Lou P, Zang D, Wang K, Ma L. A Network Meta-Analysis of the Dose-Response Effects of Dapagliflozin on Efficacy and Safety in Adults With Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:923376. [PMID: 35872994 PMCID: PMC9301373 DOI: 10.3389/fendo.2022.923376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most patients with type 1 diabetes (T1DM) do not reach the blood glucose goal with treatment of insulin. In our research, we intended to estimate the therapeutic effect and safety of additional different doses of dapagliflozin on insulin treatment in T1DM. METHODS We performed direct and indirect network meta-analysis using Bayesian models and graded different dosages of dapagliflozin by mixed therapy contrasts. We retrieved information from the PubMed, Embase, The Cochrane Library, Web of Science, China Biology Medicine (CBM) disc, China National Knowledge Infrastructure (CNKI), Wanfang Data, and WEIPU Data. Our research included randomized controlled trials (RCTs) including T1DM treated with insulin and additional dapagliflozin 5 mg or dapagliflozin 10 mg from January 2012 to June 2021. Thirteen RCTs with 10,701 participants were divided into three groups as below: insulin alone, dapagliflozin 5 mg + insulin, and dapagliflozin 10 mg + insulin. RESULTS Dapagliflozin dose-dependently exhibited reductions in glycated hemoglobin (HbA1c), total insulin daily dose (TDD), and body weight. Neither dapagliflozin 5 mg nor 10 mg could induce hypoglycemia or severe hypoglycemia. However, both doses of dapagliflozin increased the incidence of diabetic ketoacidosis (DKA) and genital infection. CONCLUSIONS Dapagliflozin 10 mg could achieve a better outcome in efficacy and could not increase the risk of hypoglycemia. Although it may induce a higher risk of DKA and genital infection, there was no significant difference between dapagliflozin 10 mg and 5 mg. Our outcomes indicate that dapagliflozin 10mg has a high reliability of being graded prior as a supplementary treatment to insulin in T1DM.
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Affiliation(s)
- Yinhui Li
- Department of Endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Hui Li
- Department of Endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Liming Dong
- Department of Clinical Nutrition, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dandan Lin
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
| | - Lijuan Xu
- Department of Endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Pengwei Lou
- Department of Medical Administration, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Deng Zang
- Department of Endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
| | - Kai Wang
- College of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China
- *Correspondence: Li Ma, ; Kai Wang,
| | - Li Ma
- Department of Endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China
- *Correspondence: Li Ma, ; Kai Wang,
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Hamaguchi M, Yoshimura Y, Nakajima H, Tanaka T, Hasegawa G, Ishii M, Okada H, Mitsuhashi K, Kitagawa N, Okamura T, Hashimoto Y, Majima S, Senmaru T, Ushigome E, Nakanishi N, Asano M, Yamazaki M, Fukui M. Insulin dose reduction in dapagliflozin combination therapy for type 1 diabetes mellitus: the RISING-STAR study. J Clin Biochem Nutr 2022; 71:158-164. [PMID: 36213793 PMCID: PMC9519412 DOI: 10.3164/jcbn.22-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 12/03/2022] Open
Abstract
To clarify the frequency of hypoglycemia in patients with type 1 diabetes mellitus receiving dapagliflozin combination therapy to reduce their basal insulin dose. Sixty subjects were assigned to two groups according to their basal insulin-to-total daily dose (TDD) ratio: group A (basal insulin/TDD <40%) and group B (≥40%). Reduction of the basal insulin dose was instituted in group B, but not in group A. The number of hypoglycemic events per day and ketosis frequency were the primary and secondary endpoints, respectively. The hypoglycemia frequency before and after the intervention was 0.23 and 0.26 times/day in group A and 0.19 and 0.23 times/day in group B, respectively, with no significant difference between the groups. The total insulin dose reduction was approximately 10% in both groups. Ketosis frequency increased significantly after the intervention (from 0.013 to 0.086 times/day in group A and 0.013 to 0.059 times/day in group B). Time-in-range, mean amplitude of glycemic excursion, and glycated hemoglobin A1c improved in both groups. No significant difference in hypoglycemia frequency was observed between patients with and without reduction of the basal insulin dose. The combination therapy improved glycemic control and patient satisfaction regarding hyperglycemia. Nevertheless, adequate attention to ketosis is crucial.
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Affiliation(s)
- Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Yuta Yoshimura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Hanako Nakajima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Toru Tanaka
- Department of Diabetes and Endocrinology, Japanese Red Cross Kyoto Daiichi Hospital
| | - Goji Hasegawa
- Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital
| | | | - Hiroshi Okada
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital
| | | | | | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Saori Majima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Mai Asano
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
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Ceriello A, Prattichizzo F, Phillip M, Hirsch IB, Mathieu C, Battelino T. Glycaemic management in diabetes: old and new approaches. Lancet Diabetes Endocrinol 2022; 10:75-84. [PMID: 34793722 DOI: 10.1016/s2213-8587(21)00245-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
HbA1c is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA1c concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA1c in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes.
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Affiliation(s)
| | | | - Moshe Phillip
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irl B Hirsch
- University of Washington School of Medicine, Seattle, WA, USA
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg KU Leuven, Leuven, Belgium
| | - Tadej Battelino
- University Medical Center Ljubljana, University Children's Hospital, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Neuman V, Plachy L, Pruhova S, Kolouskova S, Petruzelkova L, Obermannova B, Vyzralkova J, Konecna P, Vosahlo J, Romanova M, Pavlikova M, Sumnik Z. Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study. Nutrients 2021; 13:nu13113903. [PMID: 34836158 PMCID: PMC8622801 DOI: 10.3390/nu13113903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 01/31/2023] Open
Abstract
AIMS/HYPOTHESIS The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data. METHODS Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children's carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment. RESULTS A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist. CONCLUSIONS/INTERPRETATION Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.
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Affiliation(s)
- Vit Neuman
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
- Correspondence: ; Tel.: +420-2-2443-2090; Fax: +420-2-2443-2020
| | - Lukas Plachy
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
| | - Stepanka Pruhova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
| | - Stanislava Kolouskova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
| | - Lenka Petruzelkova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
| | - Barbora Obermannova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
| | - Jana Vyzralkova
- Department of Pediatrics, University Hospital Brno, CZ-62500 Brno, Czech Republic; (J.V.); (P.K.)
| | - Petra Konecna
- Department of Pediatrics, University Hospital Brno, CZ-62500 Brno, Czech Republic; (J.V.); (P.K.)
| | - Jan Vosahlo
- Department of Pediatrics, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, CZ-10034 Prague, Czech Republic; (J.V.); (M.R.)
| | - Martina Romanova
- Department of Pediatrics, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, CZ-10034 Prague, Czech Republic; (J.V.); (M.R.)
| | - Marketa Pavlikova
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, CZ-18675 Prague, Czech Republic;
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic; (L.P.); (S.P.); (S.K.); (L.P.); (B.O.); (Z.S.)
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Koike M, Saito H, Kohno G, Takubo M, Watanabe K, Ishihara H. Effects of GLP-1RA and SGLT2i, Alone or in Combination, on Mouse Models of Type 2 Diabetes Representing Different Disease Stages. Int J Mol Sci 2021; 22:ijms222111463. [PMID: 34768897 PMCID: PMC8583813 DOI: 10.3390/ijms222111463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-dependent glucose transporter 2 inhibitor (SGLT2i), in addition to lowering glucose, have pleiotropic effects on the heart, kidneys, and liver. These drugs have thus come into widespread use for treating type 2 diabetes (T2DM). However, mechanistic comparisons and effects of combining these drugs have not been adequately studied. Employing diet-induced obese (DIO) mice and db/db mice as models of the early and advanced stages of T2DM, we evaluated effects of single or combined use of liraglutide (a GLP-1RA) and ipragliflozin (a SGLT2i). Treatments with liraglutide and/or ipragliflozin for 28 days improved glycemic control and reduced hepatic lipid accumulation similarly in DIO mice. In contrast, in db/db mice, despite similar favorable effects on fatty liver, liraglutide exerted no beneficial effects on glycemic control. Improved glycemic control in db/db mice treated with ipragliflozin was accompanied by increased pancreatic β-cell area and insulin content, both of which tended to rise further when ipragliflozin was combined with liraglutide. Our data suggest that liraglutide is more efficient at an earlier stage and ipragliflozin can be effective in both stages. In addition, their combined use is a potential option for treating advanced stage diabetes with fatty liver disease.
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MESH Headings
- Animals
- Blood Glucose/metabolism
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/etiology
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Disease Models, Animal
- Drug Therapy, Combination
- Glucagon-Like Peptide-1 Receptor/agonists
- Glucosides/pharmacology
- Hypoglycemic Agents/pharmacology
- Insulin-Secreting Cells/drug effects
- Insulin-Secreting Cells/metabolism
- Insulin-Secreting Cells/pathology
- Liraglutide/pharmacology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Obese
- Sodium-Glucose Transporter 2 Inhibitors/pharmacology
- Thiophenes/pharmacology
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11
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Hamaguchi M, Hashimoto Y, Tanaka T, Hasegawa G, Ishii M, Okada H, Mitsuhashi K, Kitagawa N, Ushigome E, Yamazaki M, Fukui M. Multicenter, Open-Label, 2-Arm, Pilot Trial for Safe Reduction of Basal Insulin Dose Combined with SGLT2 Inhibitor in Type 1 Diabetes Mellitus: Study Protocol for a RISING-STAR Trial. Clin Med Insights Endocrinol Diabetes 2021; 14:11795514211040539. [PMID: 34602832 PMCID: PMC8482353 DOI: 10.1177/11795514211040539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/23/2021] [Indexed: 01/27/2023] Open
Abstract
Background: The safe method of instructing insulin dose reduction in combination with
SGLT2 inhibitors, dapagliflozin for patients with type 1 diabetes mellitus
has not been clarified. In this study, we conducted a stratified, 2-arm,
parallel comparative study with the primary endpoint of decreasing the
frequency of hypoglycemia by instructing basal insulin dose reduction. Methods: The study has a multicenter, open-label, 2-arm design; 60 type 1 diabetes
mellitus patients are being recruited from 7 hospitals. Study subjects have
been stratified into 2 groups based on the ratio of basal insulin daily dose
(Basal) to total daily insulin dose (TDD). The subjects whose Basal/TDD
ratio is <0.4 are instructed not to reduce Basal but to reduce bolus
insulin dose by 10% (group A), and subjects with a Basal/TDD ratio >0.4
will be instructed to reduce Basal by 10% (group B). The primary outcome is
the daily frequency of hypoglycemia during the intervention period (SGLT2
inhibitor administration), as determined by self-monitoring of blood
glucose. We aimed to confirm a greater reduction in frequency of
hypoglycemia in group B (reduced Basal), than in group A (non-reduction of
Basal and reduced insulin effect levels by 10%). Baseline hypoglycemia was
set at 7 ± 6 times/month. The minimum sample size required to achieve a
significance of .05 for a 1-sided t-test with a statistical
power at 80% is determined. When the sample size is 26 patients in 1 group,
the percentage increase in hypoglycemia exceeds 60%, and the sample size is
considered sufficient. Discussion: In this pilot study, we assumed that, given a sufficient Basal, hypoglycemia
would be more frequent in patients with type 1 diabetes when combined with
SGLT2 inhibitors, provided the Basal was not reduced.
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Affiliation(s)
- Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Tanaka
- Department of Diabetes and Endocrinology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Goji Hasegawa
- Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, Otsu, Japan
| | - Hiroshi Okada
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Kazuteru Mitsuhashi
- Department of Diabetes and Internal Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Noriyuki Kitagawa
- Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Vitale RJ, Laffel LM. Sodium-Glucose Transporter Inhibition in Adult and Pediatric Patients with Type 1 Diabetes Mellitus. Adv Chronic Kidney Dis 2021; 28:309-317. [PMID: 34922687 DOI: 10.1053/j.ackd.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 01/14/2023]
Abstract
Adjunctive therapies to insulin for treatment of type 1 diabetes mellitus (T1D) have gained popularity in efforts to achieve glycemic targets, and sodium-glucose transporter (SGLT) inhibitors are an appealing option due to associated weight loss, low risk of hypoglycemia, and improved cardiorenal outcomes seen in persons with type 2 diabetes mellitus. The increased risk of diabetic ketoacidosis (DKA), including euglycemic DKA, has led many to be wary of their use in T1D, especially given limited pediatric data and data regarding cardiorenal protection in this population. The phase 3 trials of these agents in T1D have yielded lower HbA1c, decreased total daily insulin dose, and small but significant weight loss with no increase in hypoglycemia. These trials also reported increased risks of genital mycotic infection and DKA. SGLT inhibitors have been approved as adjunctive therapy to insulin in adults with T1D in Europe and Japan, but the United States Food and Drug Administration has rejected similar applications. Although approaches to mitigate the risk of DKA have been developed, no randomized trials using such tools have been conducted. More research is needed to minimize the risk of DKA and to better evaluate the cardiorenal impact of these agents in persons with T1D.
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13
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Intermittent high glucose induces pyroptosis of rat H9C2 cardiomyocytes via sodium-glucose cotransporter 1. Mol Cell Biochem 2021; 476:2479-2489. [PMID: 33608832 DOI: 10.1007/s11010-021-04104-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/10/2021] [Indexed: 02/08/2023]
Abstract
Cardiomyocyte death is an important pathogenic process in cardiac complications of diabetes. Diabetic patients often suffer glycemic variability. Pyroptosis is a form of programmed cell death triggered by inflammasomes and related with caspase-1 and gasdermin D activation. The present study was designed to examine the effects of intermittent high glucose simulating glycemic variability on the pyroptosis of cardiomyocytes in vitro. Rat H9C2 cardiomyocytes were incubated with normal glucose (NG), constant high glucose (CHG) and intermittent high glucose (IHG). Results showed that compared to CHG treatment, IHG further inhibited cell proliferation and promoted cell death of H9C2 cardiomyocytes. In addition, IHG upregulated higher levels of the expressions of inflammasome NLR family pyrin domain containing 3 (NLRP3) and adaptor protein apoptosis-associated speck-like protein containing CARD domain (ASC) and increased higher levels of activated caspase-1 and gasdermin D than CHG treatment. Moreover, the production of reactive oxygen species (ROS) and activation of NF-κB that is induced by IHG were significantly higher than that induced by CHG. Knockdown of sodium-glucose cotransporters 1 (SGLT1) in H9C2 cardiomyocytes was performed and the effects of SGLT1 on IHG-induced pyroptosis was evaluated. The results demonstrated that knockdown of SGLT1 partially reduced IHG-induced pyroptosis, ROS generation and NF-κB activation. Our results indicated that IHG is harmful to cardiomyocytes and it might be partially because of the SGLT1-depedent pyroptosis in cardiomyocytes.
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14
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Huang Y, Jiang Z, Wei Y. Efficacy and safety of the SGLT2 inhibitor dapagliflozin in type 1 diabetes: A meta-analysis of randomized controlled trials. Exp Ther Med 2021; 21:382. [PMID: 33680104 PMCID: PMC7918543 DOI: 10.3892/etm.2021.9813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Abstract
Sodium glucose cotransporter-2 (SGLT2) is a sodium-dependent glucose transporter responsible for renal absorption of glucose. Dapagliflozin is an SGLT2 inhibitor used in patients with type 1 diabetes to promote urinary glucose excretion, but to date, randomized controlled trials (RCTs) to evaluate the effect of this drug in this disease have not been systematically evaluated. Therefore, the aim of the present study was to evaluate the efficacy and safety of dapagliflozin, as an adjuvant therapy to insulin, in the treatment of type 1 diabetes mellitus through a systematic review and meta-analysis. The Cochrane Library Database, Medline and Embase databases were used to search articles published between January 1st 2004 and February 5th 2020 with no language restrictions relating to RCTs. After extracting the data, the quality of the RCTs was evaluated and the data were statistically analyzed. A total of 4 RCTs with 1,691 participants were included. Dapagliflozin resulted in decreased glycosylated hemoglobin A1c (0.40-0.45%), body weight (2.52-3.85 kg), mean daily glucose (0.76-0.99 mmol/l) and mean amplitude of glucose excursion (0.54-1.07 mmol/l; all with P<0.00001) compared to placebo. Subgroup analysis by dose indicated no significant difference in all efficacy outcome indicators between dapagliflozin at 5 and at 10 mg (P>0.1). Compared with placebo, the use of dapagliflozin in patients with type 1 diabetes increased the risk of adverse events and serious adverse events (P<0.05), but did not increase the risks of infection, diabetic ketoacidosis (DKA) and discontinuation due to adverse events. Analysis by dose group suggested that no significant difference in all safety outcome indicators between dapagliflozin at 5 and at 10 mg (P>0.1). In conclusion, dapagliflozin had a significant effect on type 1 diabetes. However, the use of dapagliflozin significantly increased the incidence of adverse events and serious adverse events compared with placebo. Dapagliflozin-assisted short-term (24 weeks) insulin therapy for type 1 diabetes did not increase the risk of DKA but additional high-quality studies are required to determine its long-term efficacy and safety.
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Affiliation(s)
- Yuxin Huang
- Department of Clinical Medicine, The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zeju Jiang
- Department of Clinical Medicine, The First Clinical Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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15
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Boeder S, Kulasa K. Hospital care: improving outcomes in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2021; 28:14-20. [PMID: 33315629 DOI: 10.1097/med.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Caring for patients with type 1 diabetes (T1D) in the hospital presents unique challenges. This review provides an update on significant issues relevant to the inpatient management of T1D. Topics include trends in diabetic ketoacidosis (DKA), hypoglycemia, and adapting ambulatory technologies for inpatient use. RECENT FINDINGS Rates of DKA in the United States are rising. Although socioeconomic status, health insurance coverage, and hemoglobin A1c are persistently associated with DKA in individuals with T1D, newer risk factors have also emerged. These include the off-label use of sodium-glucose cotransporter inhibitor medications, immune checkpoint inhibitor-induced diabetes, and infection with severe acute respiratory syndrome coronavirus 2. Hypoglycemia is common among hospitalized patients with T1D. Use of validated hypoglycemia risk prediction models and multidisciplinary care initiatives can reduce the risk of inpatient hypoglycemia. Finally, continuous glucose monitoring is being adapted for use in the hospital setting and has shown promise during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY Evidence-based treatment algorithms, risk prediction calculators, multidisciplinary interventions, and wearable technology hold promise for improved outcomes in hospitalized patients with T1D.
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Affiliation(s)
- Schafer Boeder
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California, USA
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16
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Phillip M, Mathieu C, Lind M, Araki E, di Bartolo P, Bergenstal R, Heller S, Hansen L, Scheerer MF, Thoren F, Arya N, Xu J, Iqbal N, Dandona P. Long-term efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes: pooled 52-week outcomes from the DEPICT-1 and -2 studies. Diabetes Obes Metab 2021; 23:549-560. [PMID: 33145944 PMCID: PMC7839492 DOI: 10.1111/dom.14248] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the efficacy and safety of adjunct dapagliflozin therapy in patients with type 1 diabetes (T1D). MATERIALS AND METHODS DEPICT-1 and -2 were randomized, double-blind, parallel-group, 24-week studies, with 28-week extension periods. Adults with T1D and HbA1c 7.5%-10.5% were randomized (1:1:1) to receive dapagliflozin 5 mg, 10 mg or placebo. The short- and long-term efficacy and safety of dapagliflozin were examined in an exploratory pooled analysis of both studies. RESULTS Efficacy analyses included 530, 529 and 532 and safety analysis included 548, 566 and 532 patients in the dapagliflozin 5 mg, 10 mg and placebo groups, respectively. Baseline characteristics were similar between treatment groups. At week 24, reductions were seen with dapagliflozin 5 and 10 mg compared with placebo in HbA1c (-0.40%, -0.43% vs. 0.00%) and body weight (-2.45, -2.91 vs. 0.11 kg). HbA1c and body weight reductions versus placebo were also seen after 52 weeks of treatment. There was no imbalance in occurrence of severe hypoglycaemic events between groups. The proportion of patients experiencing definite diabetic ketoacidosis (DKA) was higher with dapagliflozin 5 mg (4.0%) and 10 mg (3.5%) compared with placebo (1.1%) over 52 weeks; most events were of mild or moderate severity, and all resolved with treatment. CONCLUSIONS Over 52 weeks, dapagliflozin provided glycaemic and weight benefits, with no increased frequency of severe hypoglycaemia compared with placebo. More DKA events were reported with dapagliflozin than placebo, highlighting the importance of appropriate patient selection, education and risk-mitigation strategies.
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Affiliation(s)
- Moshe Phillip
- Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of IsraelPetah TikvaIsrael
- Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Chantal Mathieu
- Clinical and Experimental EndocrinologyUniversity of LeuvenLeuvenBelgium
| | - Marcus Lind
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
- Department of MedicineNU‐Hospital GroupUddevallaSweden
| | - Eiichi Araki
- Department of Metabolic MedicineKumamoto UniversityKumamotoJapan
| | - Paolo di Bartolo
- Ravenna Internal Medicine DepartmentRavenna Diabetes Clinic, Romagna Local Health AuthorityRavennaItaly
| | - Richard Bergenstal
- International Diabetes CenterHealth Partners InstituteMinneapolisMinnesotaUSA
| | - Simon Heller
- Department of Oncology and MetabolismUniversity of Sheffield School of MedicineSheffieldUK
| | - Lars Hansen
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMarylandUSA
| | | | | | - Niki Arya
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMarylandUSA
| | - John Xu
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMarylandUSA
| | - Nayyar Iqbal
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMarylandUSA
| | - Paresh Dandona
- Department of EndocrinologyKaleida HealthBuffaloNew YorkUSA
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17
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Abu-Zaid A, Altowairqi AK, Dissanayaka T, Oganesyan A, Bhagavathul AS, Alhabeeb H, Baradhwan A, Alomar S, Tom S. A systematic review and dose-response meta-analysis on the efficacy of dapagliflozin in patients with type 1 diabetes mellitus. Pharmacol Res 2021; 165:105456. [PMID: 33515709 DOI: 10.1016/j.phrs.2021.105456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/06/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
Formulation of insulin analogs and its delivery are developed in over recent years but glycemic control in most patients with type-1 diabetes mellitus (DM) is not adequate yet. The aim of this meta-analysis is to evaluate the efficacy of dapagliflozin in patients with type-1 DM. The MEDLINE/PubMed, Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched up to Aug 2020 to identify the potential literature. Random-effects model (DerSimonian and Laird method) was used to estimate the pooled effect size as weighted mean difference (WMD) with 95 % confidence interval (CI). Five randomized placebo-controlled trials with 11 arms were included in the quantitative analysis. The pooled results suggested a significant reduction in glycated hemoglobin A1C (HbA1C; WMD: -0.36 %, 95 % CI: -0.55, -0.18), body weight (WMD: -4.02 kg, 95 % CI: -4.78, -3.25), and total daily insulin dose (TDID; WMD: -10.36 %, 95 % CI: -13.42, -7.29), as well as an increase in 24-h urinary glucose excretion (24-h UGE; WMD: 90.02 g/24-h, 95 % CI: 72.96, 107.09) in dapagliflozin group compared to control group. Dose of dapagliflozin had a significant effect on body weight reduction (Coef = -3.7, p = 0.01) and 24-h UGE (coef = 0.85, p = 0.005). Pooled results of this meta-analysis identified a significant reduction in HbA1c levels, body weight, and TDID, and a substantial increase in 24-h UGE in patients who received dapagliflozin versus placebo.
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Affiliation(s)
- Ahmed Abu-Zaid
- Department of Pharmacology, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, United States; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | | | - Thusharika Dissanayaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka; Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | | | - Akshaya Srikanth Bhagavathul
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Habeeb Alhabeeb
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amirah Baradhwan
- Department of Medicine, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Sara Alomar
- Department of Family Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
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18
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Mathieu C, Dandona P, Birkenfeld AL, Hansen TK, Iqbal N, Xu J, Repetto E, Scheerer MF, Thoren F, Phillip M. Benefit/risk profile of dapagliflozin 5 mg in the DEPICT-1 and -2 trials in individuals with type 1 diabetes and body mass index ≥27 kg/m 2. Diabetes Obes Metab 2020; 22:2151-2160. [PMID: 32691513 PMCID: PMC7693058 DOI: 10.1111/dom.14144] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 12/11/2022]
Abstract
AIM The DEPICT-1 and -2 studies (NCT02268214, NCT02460978) evaluated the efficacy and safety of dapagliflozin in individuals with type 1 diabetes who were receiving intensive insulin therapy. The DEPICT-1 and -2 studies (NCT02268214, NCT02460978) evaluated the efficacy and safety of dapagliflozin in individuals with type 1 diabetes. This post-hoc study investigated the safety and efficacy of dapagliflozin in individuals with BMI ≥27 kg/m2 to assess if the benefit/risk ratio associated with dapagliflozin treatment can be further improved than that observed in the overall DEPICT population. METHODS Changes in glycated haemoglobin (HbA1c) and body weight, percentage change in daily insulin dose and proportion of participants achieving HbA1c reduction ≥0.5% without severe hypoglycaemia were evaluated at weeks 24 and 52. Changes in mean interstitial glucose, mean amplitude of glycaemic excursions and time in target glycaemic range were evaluated at week 24. Safety was assessed until week 56. RESULTS Week-52 adjusted mean (SE) change from baseline for HbA1c was -0.26% (0.05) with dapagliflozin versus +0.08% (0.05) with placebo and for body weight was -2.74 kg (0.25) with dapagliflozin versus +0.81 kg (0.26) with placebo. Mean (SE) percentage change in daily insulin dose was -10.5% (1.23) with dapagliflozin versus -1.4% (1.36) with placebo. Time spent in target glycaemic range increased by 2.2 h/day versus placebo. Dapagliflozin was well tolerated, with fewer participants experiencing diabetic ketoacidosis (dapagliflozin, 1.7%; placebo, 1.0%) than dapagliflozin 5 mg receiving participants in the pooled DEPICT populations. CONCLUSIONS Compared with the pooled DEPICT population, the benefit/risk profile of adjunct dapagliflozin therapy was more favourable in individuals with type 1 diabetes with body mass index ≥27 kg/m2 because of the reduced risk of diabetic ketoacidosis in this population.
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Affiliation(s)
- Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ GasthuisbergUniversity of LeuvenLeuvenBelgium
| | - Paresh Dandona
- State University of New York at BuffaloWilliamsvilleNew YorkUSA
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre MunichUniversity of TübingenTübingenGermany
- German Center for Diabetes Research (DZD)TübingenGermany
- Department of Internal Medicine, Division of Endocrinology, Diabetology and NephrologyEberhard Karls University TübingenTübingenGermany
| | | | - Nayyar Iqbal
- Late‐stage Development Cardiovascular, Renal and MetabolismAstraZenecaGaithersburgMarylandUSA
| | - John Xu
- Late‐stage Development Cardiovascular, Renal and MetabolismAstraZenecaGaithersburgMarylandUSA
| | - Enrico Repetto
- Global Medical AffairsAstraZenecaGaithersburgMarylandUSA
| | | | - Fredrik Thoren
- Late‐stage Development Cardiovascular, Renal and MetabolismAstraZenecaGothenburgSweden
| | - Moshe Phillip
- Schneider Children's Medical Center of IsraelPetah TikvaIsrael
- Sacller Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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19
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Fritsche A, Heni M, Peter A, Gallwitz B, Kellerer M, Birkenfeld AL, Häring HU, Wagner R. Considering Insulin Secretory Capacity as Measured by a Fasting C-Peptide/Glucose Ratio in Selecting Glucose-Lowering Medications. Exp Clin Endocrinol Diabetes 2020; 130:200-204. [PMID: 32947641 PMCID: PMC8926455 DOI: 10.1055/a-1242-9809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andreas Fritsche
- German Center for Diabetes Research (DZD), Neuherberg.,Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
| | - Martin Heni
- German Center for Diabetes Research (DZD), Neuherberg.,Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
| | - Andreas Peter
- German Center for Diabetes Research (DZD), Neuherberg.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen.,Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Baptist Gallwitz
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
| | | | - Andreas L Birkenfeld
- German Center for Diabetes Research (DZD), Neuherberg.,Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
| | - Hans-Ulrich Häring
- German Center for Diabetes Research (DZD), Neuherberg.,Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
| | - Robert Wagner
- German Center for Diabetes Research (DZD), Neuherberg.,Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen
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Clark A, Mohammed AS, Raut A, Moore S, Houlden R, Awad S. Prevalence and Clinical Characteristics of Adults Presenting With Sodium-Glucose Cotransporter-2 Inhibitor-Associated Diabetic Ketoacidosis at a Canadian Academic Tertiary Care Hospital. Can J Diabetes 2020; 45:214-219. [PMID: 33046401 DOI: 10.1016/j.jcjd.2020.08.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES In this study, we examined the prevalence and clinical characteristics of sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated diabetes ketoacidosis (DKA). METHODS A retrospective chart review of patients admitted for DKA over 4 years. Patients with SGLT2i-associated DKA were invited for pancreatic autoantibody testing. A subset of patients were invited for an interview to identify clinical characteristics suggestive of undiagnosed latent autoimmune diabetes in adults (LADA). RESULTS Of 647 DKA admissions, 6.6% were associated with SGLT2i use. Time from SGLT2i initiation and DKA ranged from 2 weeks to 3.25 years; 69.8% had euglycemic DKA. Pancreatic autoantibody testing on 20 patients identified 5 originally diagnosed with type 2 as having LADA. Four were interviewed and had a LADA clinical risk score predictive of this diagnosis. CONCLUSIONS A larger study is needed to qualify the role of the LADA clinical risk score with confirmatory pancreatic autoantibody testing before SGLT2i initiation to reduce DKA risk.
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Affiliation(s)
- Alexa Clark
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Amol Raut
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sarah Moore
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Robyn Houlden
- Division of Endocrinology and Metabolism, Queen's University, Kingston, Ontario, Canada
| | - Sara Awad
- Division of Endocrinology and Metabolism, Queen's University, Kingston, Ontario, Canada.
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21
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Dubrofsky L, Srivastava A, Cherney DZ. Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review. Can J Kidney Health Dis 2020; 7:2054358120935701. [PMID: 32637144 PMCID: PMC7315675 DOI: 10.1177/2054358120935701] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose of the review: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended for eligible patients with type 2 diabetes for the secondary prevention of adverse cardiovascular and kidney disease outcomes. Patients with type 2 diabetes and albuminuric chronic kidney disease, a history of atherosclerotic cardiovascular disease, and/or heart failure with reduced ejection fraction should be assessed for the use of these therapies. Sources of information: The sources include published clinical trials with SGLT2is, with a focus on cardiovascular safety studies and kidney protection trials. Methods: Information was gathered via a review of relevant literature and clinical practice guidelines, incorporated with real-life clinical experience. Key findings: Clinicians prescribing these agents must be familiar with the benefits of SGLT2is on cardiovascular and renal endpoints, and with adverse effects of SGLT2is, including mycotic genital infections and diabetic ketoacidosis. Primary care physicians and specialists should know how to adjust antihypertensive, antiglycemic, and diuretic agents. With the results of completed cardiovascular outcome trials and the Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy trial, nephrologists specifically have a unique opportunity to impact the safe, effective, and equitable implementation of SGLT2is into clinical practice. Limitations: Further work is needed in specific patient subgroups, including patients with chronic kidney disease stages IV and V, patients with kidney disease but lower levels of albuminuria, and in patients without diabetes.
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Affiliation(s)
- Lisa Dubrofsky
- Division of Nephrology, University Health Network, University of Toronto, ON, Canada
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Z Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, ON, Canada.,Department of Physiology, University of Toronto, ON, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, ON, Canada.,Banting & Best Diabetes Centre, Toronto, ON, Canada
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22
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Saha S, Saha S. The comparison of efficacy and safety between different doses of empagliflozin in insulin-treated type 1 diabetes mellitus patients: a systematic review and meta-analysis protocol. J Diabetes Metab Disord 2020; 19:545-550. [PMID: 32550206 PMCID: PMC7270238 DOI: 10.1007/s40200-020-00544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The proposed review aims to compare the efficacy and safety profile of empagliflozin 25 mg with its lower dosages and placebo, respectively, in insulin-treated type 1 diabetes mellitus (T1DM) patients. METHODS Double-blinded randomized controlled trials comparing the above outcomes will be searched primarily in three electronic databases (PubMed, Embase, and Scopus) and eligible trials will be included in the proposed review. Then, from the trials recruited in the review, data of the study design, participants, interventions compared, and outcomes of interest will be extracted. Subsequently, the trials' risk of bias will be assessed using the Cochrane Collaboration's tool. The meta-analysis will be conducted with a fixed-effect or a random-effect model to estimate the mean differences (weighted or standardized) and risk ratios for the efficacy and safety-related comparable outcome data, respectively. Statistical heterogeneity will be assessed by the p-value of chi-squared statistics and I2 statistics and explained by subgroup analysis and meta-regression. Publication bias will be assessed by funnel plots and Egger's test. The sensitivity analysis will repeat the meta-analysis for respective outcomes using assumptions alternative to that used in the preliminary meta-analysis and by dropping each study at a time. RESULTS A narrative reporting will ensue if a meta-analytic comparison is not possible. CONCLUSIONS Based on the contemporary literature, the proposed review will synthesize the evidence on how the efficacy and safety profile of high dose empagliflozin varies with its lower doses and placebo, respectively, in insulin-treated T1DM patients.
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Affiliation(s)
- Sumanta Saha
- National Institute for Research in Tuberculosis, Chennai, India
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23
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Ehrmann D, Kulzer B, Roos T, Haak T, Al-Khatib M, Hermanns N. Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. Lancet Diabetes Endocrinol 2020; 8:436-446. [PMID: 32333879 DOI: 10.1016/s2213-8587(20)30042-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/02/2023]
Abstract
Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. Sociodemographic and modifiable risk factors were identified with strong evidence for an increased risk of DKA, including socioeconomic disadvantage, adolescent age (13-25 years), female sex, high HbA1c, previous DKA, and psychiatric comorbidities (eg, eating disorders and depression). Possible prevention strategies, which include the identification of people at risk based on non-modifiable sociodemographic risk factors, are proposed. As a second risk mitigation strategy, structured diabetes self-management education that addresses modifiable risk factors can be used. Evidence has found that structured education leads to reduced DKA rates. Knowledge of these risk factors and potent risk mitigation strategies are important to identify subgroups of people with an elevated DKA risk. This knowledge should also be used when adjunct therapy options with an increased DKA risk are considered. Prevention of DKA in people with type 1 diabetes is an important clinical task, which should also be addressed when SGLT inhibitors are part of therapy.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Mohammed Al-Khatib
- HealthPlus Diabetes & Endocrinology Centre, Abu Dhabi, United Arab Emirates
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany.
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24
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So EC, Liu PY, Wu SN. Effectiveness in the inhibition of dapagliflozin and canagliflozin on M-type K + current and α-methylglucoside-induced current in pituitary tumor (GH 3) and pheochromocytoma PC12 cells. Eur J Pharmacol 2020; 879:173141. [PMID: 32353360 DOI: 10.1016/j.ejphar.2020.173141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022]
Abstract
Dapagliflozin (DAPA) or canagliflozin (CANA), Na+-dependent glucose co-transporter type 2 (SGLT2) inhibitors, were used for treatment of type II diabetes mellitus. Addition of DAPA or CANA suppressed M-type K+ current (IK(M)) in pituitary tumor (GH3) and pheochromocytoma PC12 cells. The IC50 value for DAPA- or CANA-mediated inhibition of IK(M) in GH3 cells was 0.11 or 0.42 μM, respectively. The presence of DAPA (0.1 μM) shifted the steady-state activation of IK(M) to less depolarized potential without changing the gating charge of the current. During high-frequency depolarizing pulses, IK(M) magnitude was reduced by DAPA; however, DAPA-induced block of IK(M) remained effective. The amplitude of neither erg-mediated K+ current nor hyperpolarization-activated cation current in GH3 cells was modified in the presence of 1 μM DAPA. Alternatively, addition of DAPA, CANA, phlorizin or chlorotoxin effectively suppressed α-methylglucoside-(αMG-) induced current (IαMG) in GH3 cells, albeit inability of tefluthrin (activator of INa) to suppress this current. DAPA shifted the charge-voltage relation of presteady-state IαMG in a rightward and downward direction with no change in the gating charge of the IαMG. Under current-clamp recordings, subsequent additions of DAPA, but still in the continued presence of αMG, increased the firing rate of spontaneous action potentials stimulated by αMG. Our results suggested that activity of SGLT was expressed functionally in GH3 and PC12 cells. Therefore, inhibitory actions of DAPA or CANA on the amplitude and gating of IK(M) might provide a yet unidentified mechanism through which the SGLT1 or SGLT2 activity were attenuated in unclamped cells occurring in vivo.
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Affiliation(s)
- Edmund Cheung So
- Department of Anesthesia and Medical Research, An Nan Hospital, China Medical University, Tainan City, Taiwan; Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan City, Taiwan
| | - Ping-Yen Liu
- Division of Cardiovascular Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Sheng-Nan Wu
- Institute of Basic Medical Sciences, National Cheng Kung University Medical College, Tainan City, Taiwan; Department of Physiology, National Cheng Kung University Medical College, Tainan City, Taiwan.
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25
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Saha S, Saha S. A systematic review and meta-analysis of randomized controlled trials, juxtaposing the control of glycemia and blood pressure between large dose empagliflozin and placebo among type 1 diabetes patients. Int J Health Sci (Qassim) 2020; 14:40-52. [PMID: 32206059 PMCID: PMC7069660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES While empagliflozin (25 mg) is used to treat type-2 diabetes mellitus patients with optimum renal functioning, its efficacy and safety in type-1 diabetes mellitus (T1DM) is not yet established. Therefore, this study aimed to compare insulin-treated T1DM patients' (with adequate renal functioning) glycemic and blood pressure control between the 25 mg empagliflozin recipients and placebo recipients. METHODS Parallel-arm randomized controlled trials comparing the effect of daily administered 25 mg empagliflozin tablets in adjunct to insulin treatment with placebo and insulin treatment in T1DM patients with an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or more were eligible for inclusion. Trials were searched in PubMed, EMBASE, SCOPUS, and CENTRAL with no restriction on date and language. Risk of bias of trials was assessed and mean and standard deviation of glycated hemoglobin (HbA1c, in %), systolic blood pressure (mmHg), and diastolic blood pressure (mmHg) at the end of the trial period were collected, and random-effects meta-analysis was done to estimate the weighted mean difference (WMD). The meta-analysis was done in Stata statistical software. This study was conducted in June 2019. RESULTS Three relatively small-sized trials published between 2015 and 2018 were eligible for review and analyses. The trials suffered from unclear risk of performance and detection bias. The HbA1c reduction favored the intervention group (WMD = -0.478, 95% confidence intervals = -0.766--0.189, P = 0.001; I2 = 0%). The WMD of blood pressure (systolic and diastolic) did not vary between the treatment groups. CONCLUSION Evidence (of moderate quality) suggests that daily administration of empagliflozin 25 mg tablets in adjunct to insulin in T1DM patients with optimum kidney functioning is useful to achieve glycemic control compared to placebo and insulin therapy. However, the effect on blood pressure remained indistinguishable between the compared interventions.
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Affiliation(s)
- Sumanta Saha
- Department of Health Research, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India,
Address for correspondence: Dr. Sumanta Saha, National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India. Mobile: +91-8597749014. E-mail:
| | - Sujata Saha
- Department of Mathematics, Mankar College, Mankar, West Bengal, India
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26
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Chen MB, Xu RJ, Zheng QH, Zheng XW, Wang H, Ding YL, Yue MX. Effectiveness and safety of sotagliflozin adjuvant therapy for type 1 diabetes mellitus: A protocol for Systematic review and Meta-analysis. Medicine (Baltimore) 2019; 98:e16850. [PMID: 31415414 PMCID: PMC6831156 DOI: 10.1097/md.0000000000016850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) has long required insulin treatment. Sotagliflflozin (SOTA), as a dual SGLT-1/2 inhibitor, has the potential to be the first oral antidiabetic drug (OAD) to be approved for T1DM in the US market. It is important to evaluate the effectiveness of SOTA for T1DM. METHODS Web of Science, PubMed datebase, Cochrane Library, Embase, Clinical Trials, and CNKI will be searched to identify randomized controlled trials (RCTs) exploring SOTA adjuvant therapy for T1DM. Strict screening and quality evaluation will be performed on the obtained literature independently by 2 researchers; outcome indexes will be extracted. The bias risk of the included studies will be evaluated based on Cochrane assessment tool. Meta-analysis will be performed on the data using Revman 5.3 software. RESULT We will provide practical and targeted results assessing the efficacy and safety of SOTA for T1DM patients, to provide reference for clinical use of SOTA. CONCLUSION The stronger evidence about the efficacy and safety of SOTA for T1DM patients will be provided for clinicians. TRIAL REGISTRATION NUMBER PROSPERO CRD42019133099.
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Affiliation(s)
| | | | | | | | - Hua Wang
- Department of ICU, Wujin People Hospital, the Affiliated Hospital of Jiangsu University, Changzhou
| | - Yun-Long Ding
- Department of Neurology, Jingjiang People Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu
| | - Mao-Xing Yue
- The people liberation Army 306 hospital, Beijing, PR China
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27
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Boeder S, Edelman SV. Sodium-glucose co-transporter inhibitors as adjunctive treatment to insulin in type 1 diabetes: A review of randomized controlled trials. Diabetes Obes Metab 2019; 21 Suppl 2:62-77. [PMID: 31081593 PMCID: PMC6899736 DOI: 10.1111/dom.13749] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 02/06/2023]
Abstract
Many patients with type 1 diabetes (T1D) struggle to achieve glycaemic control and experience significant fluctuations in glucose concentrations, despite insulin treatment. Sodium-glucose co-transporter (SGLT)-2 inhibitors and dual SGLT-1/2 inhibitors increase glucose elimination via the kidneys and reduce hyperglycaemia via insulin-independent mechanisms. This review examines available efficacy and safety data for these agents under investigation as adjunctive therapy for T1D. Across randomized trials of up to 52 weeks, SGLT-2 inhibitors or SGLT-1/2 inhibitors as an adjunct to insulin demonstrated significant reductions in glycated haemoglobin, glucose exposure, and measures of glycaemic variability, as well as increased time in the target glycaemic range, compared with placebo. Non-glycaemic benefits included reductions in body weight and insulin doses, as well as improvements in some cardiovascular risk factors and treatment satisfaction. SGLT-2 inhibitors and SGLT-1/2 inhibitors were associated with similar rates of hypoglycaemia but a higher incidence of genitourinary infections, compared with placebo. Diabetic ketoacidosis occurred more often with SGLT-2 inhibitors and SGLT-1/2 inhibitors vs placebo, although the incidence was generally low. Risk mitigation strategies in light of clinical trial data are also discussed. Positive data from randomized controlled trials of the SGLT-2 inhibitor dapagliflozin have led to the approval of dapagliflozin as an adjunct to insulin in adults with T1D having body mass index ≥27 kg/m2 in whom insulin does not provide adequate glycaemic control in Europe and to approval as an adjunct to insulin for adults with T1D in Japan.
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Affiliation(s)
- Schafer Boeder
- Division of Endocrinology and MetabolismUniversity of California San DiegoSan DiegoCalifornia
| | - Steven V. Edelman
- Division of Endocrinology and MetabolismUniversity of California San DiegoSan DiegoCalifornia
- Taking Control of Your Diabetes, 501(c)3Solana BeachCalifornia
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28
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Saha S, Saha S. A Systematic Review and Meta-Analysis of Randomised Controlled Trials, Contrasting the Safety Profile between Sodium-Glucose Cotransporter-2 Inhibitors and Placebo in Type 1 Diabetes Mellitus Patients. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000506366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> This study aims to contrast the side effects of treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i) and placebo in insulin-treated adult type 1 diabetes mellitus (T1DM) patients. <b><i>Methods:</i></b> Double-blinded randomized controlled trials that compare the above outcome were searched in electronic databases. Next, the risk of bias in eligible studies was assessed, and comparable outcomes were compared by a random-effects meta-analysis. <b><i>Results:</i></b> Seven eligible papers comprising about 3,900 participants were studied. All trials suffered from an unclear risk of detection bias and performance bias. In comparison with the placebo group, the risk of genital infection (RR = 3.22, <i>p</i> < 0.001, 95% CI 2.31–4.49, <i>I</i><sup>2</sup> = 0%) and diabetic ketoacidosis (RR = 2.66, <i>p</i> = 0.002, 95% CI 1.45–4.89, <i>I</i><sup>2</sup> = 0%) was higher in the SGLT2i-treated group. <b><i>Conclusion:</i></b> SGLT2i treatment increased the risk of genital infection and diabetic ketoacidosis in adult insulin-treated T1DM patients.
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