There is a clear unmet clinical need in people with
Type 1 diabetes (T1DM) considering present day
insulin therapy. New
insulin analogues and novel technologies allowing more tailored
insulin administration have improved the quality of life of people with T1DM, but issues like
hypoglycemia,
weight gain and variability in
glucose profiles remain problematic. Areas covered: In this review, the clinical efficacy, safety and tolerability of
dapagliflozin, a
sodium-glucose cotransporter type 2 inhibitor, in
type 1 diabetes (T1DM) is described based on a review of phase 2 and 3 studies to date. Expert opinion:
Dapagliflozin has shown promising results as an adjunct
therapy in T1DM, resulting in better
glucose control,
weight loss and lower blood pressure. No increase in
hypoglycemia risk, in particular severe
hypoglycemia, was observed, but, in comparison with reports in
Type 2 diabetes (T2DM), genital
infections were more prevalent.
Dapagliflozin use was accompanied with decreases in
insulin doses, but, to date, only a low risk of
diabetic ketoacidosis (DKA) was reported. However, caution is needed when interpreting this data, arising from well controlled clinical trials, with intensive education programs around
ketone measurements and DKA prevention. Further studies will need to establish how high the DKA risk is and how to mitigate this in a real-world setting.