Adapted from BMJ 13 April19 Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type one diabetes Musso G, Gambino R. Cassader M, Pascheta E. BMJ 2019:365:1328
Flozins are increasingly used for patients with “double diabetes” in practice. The authors of this study searched for randomised controlled trials for the drug Sotagliflozin to find out how effective they were and what safety issues were apparent. Over three thousand patient responses were studied. There were six trials that were of moderate to good quality and they ran between four weeks and a year. The relative pluses and minus are listed.
lowered HbA1c by 0.34% (small)
reduced fasting and post meal blood sugars
reduced daily total, basal and meal insulins
reduced time in target blood sugar range
reduced body weight by 3%
reduced systolic blood pressure by 3 mmHg
reduced protein in the urine
reduced the number of hypoglycaemic events
reduced the number of severe hypoglycaemic events
On the other hand these factors were increased:
Ketoacidosis increased by a factor of x 2 to x 8 depending on the study looked at
genital tract infections increased by a factor of x 2 to x 4.5
diarrhea increased up to x 2
volume depletion events increased by up to x 4
Patients got better blood sugar results from the higher dose of 400mg Sotagliflozin compared to the 200mg dose without increasing the risk of adverse events.
Most DKA episodes occurred as the drug was being started and patients cut their insulin dose too much, in anticipation of reduced blood sugars.
My comment: The risk of DKA in type twos is not very common but is a known effect of flozins, so it is not that surprising that this is increased in type ones too. The reduction in hypoglycaemia events and severity is a new finding and suggests an increasing role for flozins in type one management.