SGLT2 Inhibitors in T1D: 'People Are Using Them Now'

This transcript has been edited for clarity.

At the Endocrine Society meeting, I had the privilege of debating Dr Andy Ahmann about whether people with type 1 diabetes should be taking SGLT2 inhibitors. Now, this is actually something I've done for a long time off-label because I know it helps some of my patients with type 1 diabetes achieve better glycemic control. But I've also been very involved with discussions about the risk for diabetic ketoacidosis (DKA).

I was asked to present the con side of using SGLT2 inhibitors in people with type 1 diabetes, and Andy talked about why we should [use them]. I'm going to give Andy's side first.

Reduce Unpredictability, Variability, and Distress

Basically, the reason to use SGLT2 inhibitors in people with type 1 diabetes is that they help patients achieve better glycemic control. But it's not that their A1c goes from 8 to 6. What I see and what my patients have told me is that it helps reduce some of the unpredictability and variability in their numbers, which helps reduce their diabetes distress and makes them feel like it's somewhat easier to manage their diabetes. You do, on average, see an A1c reduction in the range of 0.3%-0.6%. You also see some weight loss, although it's not much; it may be on the order of 1-3 kg. Obviously, there is a patient-driven desire to use these agents because it makes them feel better and it helps them manage their diabetes.