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DIABETIC KETOACIDOSIS AFTER INITIATION OF SGLT-INHIBITION UNDER HYBRID CLOSED-LOOP THERAPY IN TYPE 1 DIABETES
Abstract
Background and Aims
Despite clinical benefits and regulatory approval in Europe, there is reluctance to sodium-glucose cotransporter inhibitor (SGLTi) use in type 1 diabetes (T1D), due to increased risk of developing diabetic ketoacidosis (DKA). Not much is known about the possible risks or benefits when combining SGLTi with hybrid closed-loop (HCL) systems.
Methods
Detailed description of changes in daily insulin dosing by a Medtronic MiniMedTM 780G algorithm in a 23-year-old woman with T1D after SGLTi initiation leading to DKA.
Results
Within a few days after start of SGLTi, the HCL control algorithm reduced the autobasal and autocorrection doses (panel A and B in Figure). Meal bolus insulin doses were already reduced in the week prior to initiation of SGLTi (panel C), as a result of a lower carbohydrate intake by our patient (panel D). After start of SGLTi, meal bolus insulin doses remained at a lower level, not only due to lower carbohydrate intake, but also due to frequent activation of the ‘safe meal bolus’ (* in panel C). Taken together, there was a significant 49% reduction in total daily insulin dose in the 2 weeks after start of SGLTi, leading to development of DKA due to insulin doses below the minimum needed to prevent ketone formation.
Conclusions
We recommend caution with SGLTi use in people with T1D and concomitant Medtronic MiniMedTM 780G use, until more is known about the influence of SGLTi on HCL control algorithm functioning, in order to avoid an even greater risk of DKA.