Revolutionizing Type 1 Diabetes: AID Meets SGLT2i for Enhanced Control
D-coding the Article - Automated Insulin Delivery with SGLT2i Combination Therapy in Type 1 Diabetes
Published Date:
November 7, 2022
Published By:
Jose Garcia-Tirado, PhD, Leon Farhy, PhD, Ralf Nass, MD, Laura Kollar, RN, Mary Clancy-Oliveri, MS, 1 Rita Basu, MD, Boris Kovatchev, PhD, and Ananda Basu, MD
Approved By:
TO BE
Decoded By:
Asra H. Ahmed
MBA, PGCE in Assessment Learning disability, Diabesties Foundation
10 mins to read
- The T1D Takeaway
- Scientist have found the Robin (SGLP2) to my Batman: insulin! This new sidekick helps me spend more time in the “blood sugar sweet spot,” so I am winning the glucose game almost two hours longer each day. The plot has a twist, with an occasional ketone drama but AID superheroes can help us navigate that hurdle and achieve safer time in range.
Word Wizard
- In this study, researchers tested if adding a small dose of a medicine called SGLT2 inhibitor (SGLT2i) to insulin could help people with Type 1 Diabetes keep their blood sugar steady by helping the body get rid of extra glucose without causing low blood sugar (hypoglycemia).
- The study included 39 people with T1D, and out of those, 34 were checked for how well they did use two different setups: some used a little bit of SGLT2i (called EMPA), and some didn’t (NOEMPA
- People using the medicine spent more time in their target blood sugar range than those who didn’t.
- With the automatic insulin system, they were in range 81% of the time compared to 71% without the medicine, and with the safety suspend system, they were in range 80% of the time compared to 63%. One person using the medicine had high blood sugar due to a blocked insulin pump.
Summary Snap
Shots
The big idea here is that empagliflozin could be a helpful teammate to smart insulin systems, such as automated insulin pumps with CGM. Scientists want to tweak the way these systems work so they’re even safer. They’re figuring out how to make these adjustments so that using empagliflozin with these smart insulin systems can be a game-changer in blood sugar management without adding any extra risks.
Prime Insight
Scientists wanted to see if adding a small dose of a medicine called empagliflozin (which helps lower blood sugar in a different way) could improve blood sugar control during the day for people using automated insulin systems, that help manage blood sugar by automatically adjusting insulin.
After meals, blood sugar can go up quickly, and insulin sometimes doesn’t work fast enough to bring it down. Empagliflozin can help lower blood sugar by sending extra glucose out of your body through urine, which could work well alongside insulin systems.
By adding a small dose of a medicine called empagliflozin (just 5 mg) to advanced insulin systems people living with Type 1 Diabetes were able to keep their blood sugar in the target range for an extra 1.6 hours every day!
That’s nearly two more hours of balanced blood sugars each day, all without extra lows.
It was found a low dose of empagliflozin (5 mg) helped keep blood sugars steadier during the day, especially after meals.
Adding the SGLT2 inhibitor (SGLT2i) didn’t increase the risk of going too low, but while empagliflozin has benefits, it can sometimes increase the risk of DKA. However close monitoring and using a low dose minimizes this risk.
Even with the low dose, there’s still a chance of developing something called diabetic ketoacidosis (DKA),which can happen when ketones build up.
While this combo shows a lot of promise, future insulin systems will need smarter ways to keep an eye on ketone levels to make sure everything stays safe and effective.
It was recommended in this study to make it safer for people living with Type 1 Diabetes to use SGLT2 inhibitor with automated insulin deliver system, so that insulin can be suspended, and sensors alert the user ahead of a predicted low.
This study suggests that empagliflozin could be a helpful “sidekick” to advanced insulin systems for better blood sugar control in Type 1 Diabetes, but they need to keep safety in mind, especially regarding ketone levels.
- A Deeper Dive
- The Sources Voice
Currently, the use of SGLT inhibitors as adjuvant therapy to AID in T1D faces significant challenges with respect to the risk of DKA, reflected in the reluctance of regulatory bodies, both in the United States and Europe, to grant approval to these therapies. Nevertheless, the associated glycemic and cardiovascular benefits of these therapies, including the results of this pilot trial, are substantial and many current efforts are directed to address the DKA risk in the T1D population
- Curiosities Clarified
Yes, the study showed that adding a small dose of empagliflozin helped people spend more time in their target blood sugar range during the day.
No, the study found that using empagliflozin with insulin systems did not lead to more low blood sugars.
Yes, even with a low dose, there was still a risk of ketone buildup, which can lead to DKA, a serious condition.
Yes, it improved daytime blood sugar control, but safety adjustments are needed to handle the ketone risk effectively.
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