Triple Therapy in Type 1 Diabetes Improves Glycemic Control but Carries Ketosis Risks — Physician’s First Watch

Medical News |
August 5, 2016

Triple Therapy in Type 1 Diabetes Improves Glycemic Control but Carries Ketosis Risks

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Adding dapagliflozin to liraglutide and insulin in patients with type 1 diabetes lowers hemoglobin A1c levels but poses risk for ketoacidosis, according to a small trial in the Journal of Clinical Metabolism & Endocrinology. Dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, is approved to treat type 2 diabetes.

Thirty adults who were receiving insulin plus at least 6 months of liraglutide were randomized to receive add-on dapagliflozin or placebo daily for 12 weeks. At the end of treatment, the mean HbA1c level had fallen by 0.66% and the average body weight had fallen by 1.9 kg in the triple-therapy group. The placebo group saw no significant changes.

Diabetic ketoacidosis, a known risk of SGLT-2 inhibitors, developed in two dapagliflozin recipients. The drug was also associated with increases in mediators of ketosis, including glucagon, hormone-sensitive lipase, and free fatty acids.

(Note: Some of the researchers report financial ties to dapagliflozin's manufacturers.)

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