Newer oral diabetes meds could provide significant benefits in type 1 diabetes

A retrospective chart review found that glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors were associated with benefits including weight loss and reduced use of insulin in patients with type 1 diabetes.

Glucagon-like peptide-1 (GLP-1) receptor agonists were associated with reductions in weight, HbA1c level, and daily dose of insulin, while sodium-glucose cotransporter-2 (SGLT-2) inhibitor users had reductions in HbA1c level and basal insulin requirement, a study of patients with type 1 diabetes found.

To determine the efficacy and safety of the drug classes in real-world practice, researchers conducted a retrospective chart review of all uses of the drugs for more than 90 days in adult patients with type 1 diabetes at a single academic center. There were 76 patients who used a GLP-1 receptor agonist and 39 patients who had used an SGLT-2 inhibitor for more than 90 days. Results were published Oct. 21 by the Journal of Clinical Endocrinology & Metabolism.

Over one year, patients taking GLP-1 receptor agonists had significant reductions in weight (90.5 kg to 85.4 kg; P<0.001), HbA1c level (7.7% to 7.3%; P=0.007), and total daily dose of insulin (61.8 units to 41.9 units; P<0.001). SGLT-2 inhibitor users had significant reductions in HbA1c level (7.9% to 7.3%; P<0.001) and basal insulin (31.3 units to 25.6 units; P=0.003). GLP-1 receptor agonists were associated with more weight loss (P=0.027), while the HbA1c reduction was comparable between groups.

More SGLT-2 inhibitor users experienced diabetic ketoacidosis (12.8% vs. 3.9%) over a mean total use of 29.5 months per patient. Adverse events were the cause of cessation of therapy in 26.9% of the GLP-1 receptor agonist users and 27.7% of the SGLT-2 inhibitor users. The study authors noted that diabetic ketoacidosis remains a clinical concern with SGLT-2 inhibitors, requiring careful patient selection and monitoring.

They concluded, “Most importantly, to adequately determine the risk-benefit of these agents in those with T1DM [type 1 diabetes], it is paramount that the knowledge regarding the demonstrated long-term cardio-renal outcomes in those with [type 2 diabetes] is translated to patients with T1DM, who also are at significant risk of such complications.”