Sodium ‐glucose co‐transporter 2 (SGLT2) inhibitors as add‐on therapy to insulin for type 1 diabetes mellitus: Systematic review and meta‐analysis of randomized controlled trials

New treatments for type 1 diabetes are an unmet need. We investigated the efficacy and safety of adding SGLT‐2is to insulin for type 1 diabetes by meta‐analysis of prospective randomized, placebo‐controlled trials. Searching electronic databases up to October 2017 identified 1361 studies, among which 14 were investigated (N=4,591). Meta‐analysis revealed that SGLT‐2i therapy significantly reduced HbA1c by 0.4% (95% confidence interval [CI]: 0.35, 0.46; P<0.001; I2=0%), fasting plasma glucose by 1.14 mmol/l (0.8,1.47), body weight by 2.68 kg (2.0, 3.36), and systolic blood pressure by 3.37 mmHg (1.46, 5.28). In addition, bolus insulin decreased by 3.6 units/day (2.0, 5.3), and basal insulin decreased by 4.2 units/day (2.2, 6.3). Continuous glucose monitoring showed a decrease of glucose excursions compared to placebo, with reduced variation of mean blood glucose, the glucose standard deviation, and the mean amplitude of glucose excursion. There was no significant increase of hypoglycemia or severe hypoglycemia. However, SGLT‐2i therapy increased diabetic ketoacidosis [OR: 3.38] and genital tract infection [OR: 3.44]. Add‐on SGLT‐2i therapy might be advantageous for type 1 diabetes, but its use should be considered carefully.
Source: Diabetes, Obesity and Metabolism - Category: Endocrinology Authors: Tags: BRIEF REPORT Source Type: research