Rodica Busui, United States of America
University of Michigan
Internal Medicine/ Metabolism, Endocrinology and Diabetes
Rodica Busui, MD, PhD, is the Larry D. Soderquist Professor of Diabetes, and a recognized national and international leader in the field of diabetes and diabetes complications. She is the Vice Chair for Clinical & Health Outcomes Research in the Department of Internal Medicine, and Director of Clinical Research, Mentoring and Development of the Caswell Diabetes Institute at the University of Michigan. Her research interests involve chronic complications of diabetes, particularly diabetic peripheral and cardiovascular autonomic neuropathy, diabetic foot complications, diabetic kidney disease, the cardiovascular complications of diabetes, as well the design and conduct of traditional and pragmatic clinical trials in diabetes and diabetes complications. Professor Busui has been PI and member of the Steering Committee in many landmark diabetes clinical trials and studies, has published more than 250 peer-reviewed manuscripts and book chapters. She has chaired the 2017 ADA Position Statement on Diabetic Neuropathy, has served as Chair of the ADA Scientific Research Review Clinical, Chair of the ADA Diabetes & Cardiovascular Disease Interest Group, and chairs the DCCT/EDIC Research Review Committee and the Precision Prognostic in Type 1 Diabetes Working Group of the ADA/EASD. She is the 2023 President for Medicine and Science of the American Diabetes Association.

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 Conference Calendar

IS019 - SGLT inhibitors in T1D: DKA risk and DKA risk mitigation strategies, especially CGM-CKM, to enable therapy use for heart and kidney health (ID 211)

Presenter
Lecture Time
17:00 - 17:20
Session Name
0470 - PARALLEL SESSION - JDRF SESSION - CONTINUOUS KETONE MONITORING FOR TYPE 1 DIABETES
Session Type
PARALLEL SESSION
Date
Thu, 23.02.2023
Session Time
16:40 - 18:10
Room
Hall A1
Session Icon
Live Q&A

Abstract

Abstract Body

Despite continous progress in the development and implementation of diabetes technologies (including automated insulin delivery systmes) into the clinical care for people with type 1 diabetes (T1D), only 20% T1D individuals meet the evidence-based A1c target shown to prevent chronic complications such as renal and cardiovascular disease (CVD). Additionally, a solley intensive insulin management regimen is associated with residual challenges such as overweight/ obesity, high disease self-management burden, substantial diabetes-related emotional distress, fear of hypoglycemia. Diabetic kidney disease (DKD) remains the leading cause of end-stage kidney disease (ESKD) in the USA and developed world despite improvements in glycemia management and the use of renin-angiotensin system blockade, with incidence rates of 30-40% in T1D. Also, heart failure has emerged as the most prevalent CVD complication in people with T1D, while DKD markedly increases the risk of CVD and heart failure, leading causes of increased mortality in T1D. For people with type 2 diabetes, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emmerged to effectively prevent CVD and DKD progression and associated severe outcomes including death. Whether similar results can be achieved in T1D remains unknown because traditionally people with T1D were excluded from the larger CVD and CKD outcome trials. Add-on to insulin SGLTi therapy was shown to associate with significant glycemic, weight loss, and blood pressure benefits in several randomized clinical trials , and have been approved in Europe and in Japan for use in T1D. However, there are concerns about a causally increase in risk of diabetic ketoacidosis (DKA) with SGLT2i therapy in T1D. Background risk of DKA in the contemporary T1D population remains high, estimated at 5-7%. Furthermore, DKA is substantially more common in the underprivileged (lower socioeconomic class, certain ethnicities), among those struggling the most with self-management, younger age, and higher A1c. SGLTi is designated a component cause as it is neither necessary for the occurrence of DKA (the outcome is known to occur from other factors in the absence of SGLTi), nor sufficient (the outcome requires another precipitating factor in addition to the SGLTi such as illness, infection, starvation, or insulin pump malfunction). Mitigation strategies created by expert clinician and researcher panels have been published, though their implementation in clinical practice and their acceptatbility to patients and healthcare providers is not known. Data on the prevalence and risk of DKA in contemporary populations with T1D, the risk with SGLT2i as well optimal mitigation strategies will be dicussed.
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