Introduction: SGLT2 inhibitors slow CKD progression but none are approved in T1D due to risk of ketosis-related adverse events, including DKA. We evaluated the impact of dapagliflozin on glucose metrics, insulin requirements and BHOB.
Methods: After informed consent, 20 participants with T1D completed two weeks of outpatient care while monitoring capillary BOHB, both with and without open label dapagliflozin (10 mg) in a randomized crossover design. Glycemic metrics were monitored via CGM, and insulin use was recorded from pump download or self-reports in MDI users. BOHB (Precision Xtra®, Abbott) measurements were obtained up to 3X daily during the study periods.
Results: Participant age was 48 ± 18 years, 45% female, A1c 7.0 ± 0.9%, baseline TIR 61 ± 18% (mean ± SD). The baseline median insulin TDD was 57 (38 - 88). Sixteen patients used CSII and 4 MDI. SGTL2i use led to a 6.9% reduction in median TDD, 26.3% in basal doses. Participants averaged 36 cBHOB measurements in both usual care and SGLT-2 treatment phases. During usual care, there were 3 ketosis events (cBOHB > 1.5 mmol/L) versus 10 during SGLT-2 treatment (P=0.11). Most ketosis events occurred in one individual over a 24hr period. No DKA occurred.
Conclusion: In adults with T1D, dapagliflozin use was associated with reduction in insulin doses and improvement in GMI. Ketosis events were concentrated in 1 participant.
A.M. Markov: None. K.E. Jones: None. M.C. Petersen: None. P. Krutilova: None. A.M. McKee: Advisory Panel; Medtronic, Novo Nordisk. Employee; Novo Nordisk. K.L. Bohnert: None. S.E. Adamson: None. M. Salam: None. J.B. McGill: Advisory Panel; Bayer Inc., Boehringer-Ingelheim, ClearNote Health, Lilly Diabetes, MannKind Corporation, Novo Nordisk. Research Support; Novo Nordisk.
