A recent study published in the Diabetes, Obesity, and Metabolism Journal demonstrated that a greater blood and breath ketone concentration was observed in type 1 diabetes patients undergoing dapagliflozin treatment compared to those receiving usual care, who withdrew insulin under supervision.
An increased risk of ketoacidosis is seen in type 1 diabetes patients using Sodium-glucose cotransporter 2 (SGLT2) inhibitors. The study aimed to compare the risk of ketoacidosis with and without dapagliflozin treatment in individuals with type 1 diabetes who underwent insulin withdrawal under supervision, by measuring parameters such as capillary blood and plasma β-hydroxybutyrate (BOHB), breath acetone (BrACE), and blood glucose.
The study included 20 T1D adults. Researchers conducted a randomised crossover design in these individuals during supervised insulin withdrawal at usual care and after dapagliflozin treatment (10 mg daily for 2 weeks plus the test day). Parameters such as BrACE, capillary blood glucose, and BOHB were measured hourly until stopping rules were met (>8 h elapsed, symptoms of ketosis, glucose >400 mg/dL, BOHB >4 mmol/L, or participant request) after insulin withdrawal.
Results showed that, compared to usual care, significantly greater BOHB and BrACE concentrations were observed in the dapagliflozin arm during supervised insulin withdrawal. BOHB >1.5 mmol/L and >2.5 mmol/L were achieved by a greater proportion of participants undergoing dapagliflozin treatment during supervised insulin withdrawal. However, the dapagliflozin arm showed a greater reduction in blood glucose peak.