A retrospective study conducted in Japan has revealed important insights into the response of people with type 1 diabetes mellitus (T1DM) to SGLT2 inhibitor (SGLT2i) therapy in clinical settings. The study, published in Journal of Diabetes Investigation, suggested the need for careful insulin dose adjustments and patient-specific risk assessments to reduce the risk of hypoglycemia and therapy discontinuation.

Researchers reviewed the electronic medical records of 49 individuals with T1DM who began SGLT2i treatment between December 2018 and October 2021. At the time of treatment initiation, only five patients had favorable glycemic control (defined as HbA1c < 7.5%), while the remaining 44 were classified as having poor glycemic control (HbA1c ≥ 7.5%).

Among those with favorable glycemic control, very few adjusted their total daily insulin dose as recommended. In contrast, 75% of patients with poor glycemic control appropriately reduced their insulin doses upon initiating SGLT2i therapy. The study found that 60% of all patients experienced hypoglycemia before starting the SGLT2i. Among patients who had no hypoglycemic episodes before treatment, 50% developed hypoglycemia after starting SGLT2i therapy.

Patients who had hypoglycemia after drug initiation had a longer duration of diabetes and lower body weight than those not experiencing hypoglycemia after drug initiation. Diuretic use was a significant independent risk factor for SGLT2i therapy discontinuation.