Adjunctive therapies for type 1 diabetes mellitus (T1DM) may improve glycemic control beyond insulin therapy alone, although comparative continuous glucose monitoring outcomes remain limited. A randomized crossover trial published in Endocrine Practice compared dapagliflozin and acarbose as adjuncts to insulin therapy in adults with T1DM.
The prospective open-label trial enrolled adults aged 18 to 60 years with T1DM and hemoglobin A1c levels of 9.0% or lower. Participants received dapagliflozin 10 mg once daily and acarbose 50 mg three times daily for 4 weeks each, separated by a 2-week washout period. Blinded continuous glucose monitoring was performed during the final 14 days of each treatment period. The primary endpoint was time in range (TIR) between 3.9 and 10.0 mmol/L. Forty-four participants completed both treatment periods.
Findings
- Dapagliflozin increased TIR from 55.4% at baseline to 68.2% during treatment (P < 0.001).
- Compared with acarbose, dapagliflozin demonstrated higher TIR (68.2% vs 56.0%; P < 0.001).
- Dapagliflozin also reduced mean glucose levels and glycemic variability measures including standard deviation of blood glucose and largest amplitude of glycemic excursions (both P < 0.01).
- Acarbose reduced postprandial glucose excursions compared with baseline (P = 0.001).
- Total daily insulin dose was lower during dapagliflozin treatment than during acarbose treatment (31.94 U vs 35.63 U; P = 0.001).
- Hypoglycemia frequency did not significantly differ between treatments, and no diabetic ketoacidosis events occurred during the study.
The trial demonstrated improved CGM-derived glycemic control and lower insulin requirements with adjunctive dapagliflozin compared with acarbose in adults with T1DM. Longer-term studies are needed to further evaluate durability and safety outcomes.
