When innovations collide: The adjunct use of SGLT2 inhibitors or GLP1-receptor agonists with automated insulin delivery for type 1 diabetes
Abstract
A minority of those with type 1 diabetes (T1D) are able to achieve glycated hemoglobin targets of ≤ 7% to reduce complication risk. Hybrid closed-loop therapy has shown to significantly improve glycemic control. Unfortunately, not everyone is able to achieve glycemic targets, and there is a growing obesity epidemic in T1D. This thesis focusses on the effects of empagliflozin (a sodium-glucose-linked co-transporter inhibitor) and semaglutide (a glucagon-like-peptide-1 receptor agonist) in concomitant use (i.e. "adjunctive therapy") with hybrid closed-loop therapy in T1D. The first study is a three-way, randomized, cross-over, double-blinded trial to assess the effects of empagliflozin 2.5 mg and 5 mg (vs. placebo) on glycemic control in adults with type 1 diabetes who did not achieve glycemic targets on hybrid closed-loop therapy alone. Twenty-four participants entered the trial. The mean time-in-range between 3.9 and 10 mmol/L increased by 12.6% with empagliflozin 2.5 mg compared to placebo (p<0.0001), and increased by 11.2% with empagliflozin 5 mg vs. placebo (p<0.0001). Time spent in hypoglycemia was not increased by empagliflozin 2.5 mg compared to placebo, but increased with empagliflozin 5 mg by 0.5% (p= 0.0051). Daily insulin requirements were reduced with both empagliflozin doses compared to placebo. There were no statistical differences in daily morning ketone levels between all empagliflozin groups vs. placebo. Semi-structured interviews at the end of the study…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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