Triple Therapy in Type 1 Diabetes Improves Glycemic Control but Carries Ketosis Risks — Physician’s First Watch
Triple Therapy in Type 1 Diabetes Improves Glycemic Control but Carries Ketosis Risks
By Amy Orciari Herman
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.)