Background and Aims / Part 1

Several issues still exist with present day insulin therapy, with insufficient matching of insulin profiles to insulin needs resulting in many people with type 1 diabetes not reaching HbA1c targets and suffering from recurrent hypoglycemia. This risk of hypoglycemia, in particular nocturnal hypoglycemia, impacts on quality of life and contributes to weight gain via defensive snacking. Intuitively, clinicians have been experimenting with non-insulin adjunctive therapies in type 1 diabetes, typically by introducing agents used in people with type 2 diabetes. As such, metformin has been used, with however, few and rather discouraging data on long term effects. Recently, novel agents, like GLP-1 receptor agonists and SGLT2/SGLT1-2 inhibitors have been or are being tested as adjunct therapies, with interesting results.

Conclusions / Part 4

In Europe, dapagliflozin and sotagliflozin have been approved for use in people with T1D as low doses and provided the user has a BMI>27kg/m2 and receives education on how to prevent evolution to diabetic ketoacidosis.

In the meantime, real world evidence on use of SGLT inhibitors is accumulating and allows a better characterization of the optimal patient profile to use these agents in as well as design of mitigation strategies for diabetic ketoacidosis.

Evidence and clinical experience will be discussed.