Background and Aims: No studies have compared insulin dose or hypoglycemic risks between type 2 diabetes mellitus (T2DM) treated with and without Sodium glucose cotransporter-2 (SGLT2) inhibitors using defined criteria for insulin dose adjustment to achieve the same level of glycemic control. The aim of this study was to evaluate the efficacy of canagliflozin in reducing the required insulin dose and the risk of hypoglycemia in T2DM.

Materials and Methods: This randomized, two-group comparative study was conducted in 34 patients treated with insulin alone or combined with oral hypoglycemic agents. They were randomly assigned to the control (n=17, insulin) and canagliflozin (n=17, insulin plus 100 mg/day) groups and wore a continuous glucose monitoring (CGM, ipro2®) for 14 days. In both groups, a defined insulin dose adjustment protocol was applied to achieve the same level of glycemic control.

Results: The change from baseline in daily insulin dose was significantly smaller in the canagliflozin group (3.9 units/day) than control group (13.4 units/day; p = 0.040). Low blood glucose index (LBGI) and predicted % of blood glucose (BG) <70 mg/dL, which are hypoglycemia-related parameters, worsened significantly in the control group, but both remained unchanged in the canagliflozin group. The SD for nighttime BG levels improved significantly only in the canagliflozin group. Participants’ body weight (BW) decreased in both groups, but the change in BW showing a significant decrease in the canagliflozin group.

Conclusion: Supplementation of insulin therapy with 100 mg canagliflozin in patients with T2DM reduced the required insulin dose and hypoglycemic risk and flattened nighttime glycemic fluctuations while maintaining the same level of glycemic control. The addition of SGLT2 inhibitors may provide several benefits to patients on insulin therapy, enabling them to maintain strict glycemic control.


K. Torimoto: None. Y. Okada: None. Y. Sato: None. Y. Tanaka: None.

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