Sodium-Glucose Cotransporter Inhibition in Type 1 Diabetes Management

Sodium-glucose cotransporter (SGLT) inhibition represents a novel adjunct to insulin therapy in type 1 diabetes by targeting renal and, in the case of dual inhibitors, intestinal glucose handling. By blocking SGLT2 in the proximal renal tubule, these agents promote glucosuria, thereby lowering plasma glucose independently of insulin. Clinical effects include modest reductions in glycated haemoglobin, weight loss and decreased insulin requirements. Beyond glycaemic control, SGLT2 inhibitors confer cardiovascular and renal benefits, notably stabilisation of glomerular filtration and reduction in heart failure events. However, this approach carries an elevated risk of diabetic ketoacidosis and genitourinary infections, necessitating rigorous patient selection, education and monitoring. The advent of dual SGLT1/2 inhibitors further attenuates postprandial glucose excursions by delaying intestinal absorption, offering an additive mechanism to improve metabolic control. Collectively, these developments underscore the global significance of SGLT inhibition as a precision-medicine strategy in type 1 diabetes, balancing efficacy with safety through tailored therapeutic algorithms.

Research from Nature Portfolio

Recent meta-analytical evidence has consolidated the role of SGLT2 inhibitors as an adjunct to insulin in type 1 diabetes. A comprehensive analysis of seven randomised controlled trials (581 patients) demonstrated significant improvements: fasting plasma glucose decreased by 0.7 mmol/L, glycated haemoglobin by 0.37 %, body weight by 2.5 kg and total daily insulin dose by 6 IU. Overall adverse-event rates were similar to placebo, aside from a modest rise in diabetic ketoacidosis. These findings provide a foundational efficacy and safety profile, informing clinical guidelines and the design of longer-term outcome studies.

Sodium-Glucose Cotransporter Inhibition in Type 1 Diabetes Management publication trend

The graph below shows the total number of articles in sodium-glucose cotransporter inhibition in type 1 diabetes management across all publications each year (not limited to Nature Index journals).

Technical terms

Sodium-glucose cotransporter 2 (SGLT2) inhibitor: A drug that blocks renal reabsorption of filtered glucose in the proximal tubule, promoting urinary glucose loss.

Diabetic ketoacidosis (DKA): An acute metabolic emergency marked by insulin deficiency, hyperglycaemia, ketonaemia and metabolic acidosis.

Glycated haemoglobin (HbA1c): The fraction of haemoglobin irreversibly bound to glucose, reflecting average blood glucose over the preceding two to three months.

Estimated glomerular filtration rate (eGFR): A calculated index of renal function based on serum creatinine, age, sex and other factors.

Estimated glucose disposal rate (eGDR): A surrogate measure of insulin sensitivity derived from clinical parameters, used to predict metabolic risk and treatment response.

References

1. SGLT inhibitor adjunct therapy in type 1 diabetes. Diabetologia (2018).
2. The efficacy and safety of SGLT2 inhibitors for adjunctive treatment of type 1 diabetes: a systematic review and meta-analysis. Scientific Reports (2017).
3. SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes: a real-world study. Diabetologia (2023).
4. Assessing the risk of ketoacidosis due to sodium-glucose cotransporter (SGLT)-2 inhibitors in patients with type 1 diabetes: A meta-analysis and meta-regression. PLOS Medicine (2020).
5. Sotagliflozin, the first dual SGLT inhibitor: current outlook and perspectives. Cardiovascular Diabetology (2019).
6. Sotagliflozin Decreases Postprandial Glucose and Insulin Concentrations by Delaying Intestinal Glucose Absorption. The Journal of Clinical Endocrinology & Metabolism (2019).