Empagliflozin in type 1 diabetes

Chantal Mathieu, Laura Van Den Mooter, Bert EeckhoutEndocrinology, UZ Gasthuisberg, Leuven 3000, BelgiumCorrespondence: Chantal MathieuEndocrinology, UZ Gasthuisberg, Herestraat 49, Leuven 3000, BelgiumEmail chantal.mathieu@uzleuven.beAbstract: There is a clear unmet need in people living with type...

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Autores principales:	Mathieu C, Van Den Mooter L, Eeckhout B
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	type 1 diabetes SGLT2 inhibitor empagliflozin EASE trials Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/98d3c9d7fe344aa798dd92c4723adf3c
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spelling	oai:doaj.org-article:98d3c9d7fe344aa798dd92c4723adf3c2021-12-02T10:55:16ZEmpagliflozin in type 1 diabetes1178-7007https://doaj.org/article/98d3c9d7fe344aa798dd92c4723adf3c2019-08-01T00:00:00Zhttps://www.dovepress.com/empagliflozin-in-type-1-diabetes-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Chantal Mathieu, Laura Van Den Mooter, Bert EeckhoutEndocrinology, UZ Gasthuisberg, Leuven 3000, BelgiumCorrespondence: Chantal MathieuEndocrinology, UZ Gasthuisberg, Herestraat 49, Leuven 3000, BelgiumEmail chantal.mathieu@uzleuven.beAbstract: There is a clear unmet need in people living with type 1 diabetes (T1D). Although the quality of life of people with T1D has improved, issues like hypoglycemia, weight gain and variability in glucose profiles remain. In this review, the clinical efficacy and safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor in T1D, is described based on a review of phase 2 and 3 studies to date. Empagliflozin and SGLT2 inhibitors, in general, are effective glucose-lowering drugs, which also work in people with T1D. Recent phase II and III studies, including the EASE trials for empagliflozin, showed a clear beneficial effect on HbA1c, body weight, glucose variability and total daily insulin use in people with T1D. No increase in hypoglycemia risk, in particular severe hypoglycemia, was observed, but genital infections were more prevalent. The use of SGLT2 inhibitors comes with a decrease in insulin doses, making individuals more prone to diabetic ketoacidosis (DKA). The uniqueness of the EASE program is that here, a very low dose of empagliflozin was used, with less, but still present, effects on metabolic outcomes, but interestingly a lower risk of DKA. Importantly, even in the higher doses of empagliflozin, it is clear that the overall risk for DKA remains low, most likely by educating patients and caretakers intensively on this subject. In conclusion, evidence is building on the potential of using empagliflozin, like other SGLT2 inhibitors, in T1D. However, to date, the use of empagliflozin is not approved in people with T1D. Clinicians will have to weigh the potential short- and long-term benefits of these adjunct therapies versus the potential acute side effects, in particular, the small but real risk of DKA in the individual T1D patient.Keywords: type 1 diabetes, SGLT2 inhibitor, empagliflozin, EASE trialsMathieu CVan Den Mooter LEeckhout BDove Medical Pressarticletype 1 diabetesSGLT2 inhibitorempagliflozinEASE trialsSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 12, Pp 1555-1561 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	type 1 diabetes SGLT2 inhibitor empagliflozin EASE trials Specialties of internal medicine RC581-951
spellingShingle	type 1 diabetes SGLT2 inhibitor empagliflozin EASE trials Specialties of internal medicine RC581-951 Mathieu C Van Den Mooter L Eeckhout B Empagliflozin in type 1 diabetes
description	Chantal Mathieu, Laura Van Den Mooter, Bert EeckhoutEndocrinology, UZ Gasthuisberg, Leuven 3000, BelgiumCorrespondence: Chantal MathieuEndocrinology, UZ Gasthuisberg, Herestraat 49, Leuven 3000, BelgiumEmail chantal.mathieu@uzleuven.beAbstract: There is a clear unmet need in people living with type 1 diabetes (T1D). Although the quality of life of people with T1D has improved, issues like hypoglycemia, weight gain and variability in glucose profiles remain. In this review, the clinical efficacy and safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor in T1D, is described based on a review of phase 2 and 3 studies to date. Empagliflozin and SGLT2 inhibitors, in general, are effective glucose-lowering drugs, which also work in people with T1D. Recent phase II and III studies, including the EASE trials for empagliflozin, showed a clear beneficial effect on HbA1c, body weight, glucose variability and total daily insulin use in people with T1D. No increase in hypoglycemia risk, in particular severe hypoglycemia, was observed, but genital infections were more prevalent. The use of SGLT2 inhibitors comes with a decrease in insulin doses, making individuals more prone to diabetic ketoacidosis (DKA). The uniqueness of the EASE program is that here, a very low dose of empagliflozin was used, with less, but still present, effects on metabolic outcomes, but interestingly a lower risk of DKA. Importantly, even in the higher doses of empagliflozin, it is clear that the overall risk for DKA remains low, most likely by educating patients and caretakers intensively on this subject. In conclusion, evidence is building on the potential of using empagliflozin, like other SGLT2 inhibitors, in T1D. However, to date, the use of empagliflozin is not approved in people with T1D. Clinicians will have to weigh the potential short- and long-term benefits of these adjunct therapies versus the potential acute side effects, in particular, the small but real risk of DKA in the individual T1D patient.Keywords: type 1 diabetes, SGLT2 inhibitor, empagliflozin, EASE trials
format	article
author	Mathieu C Van Den Mooter L Eeckhout B
author_facet	Mathieu C Van Den Mooter L Eeckhout B
author_sort	Mathieu C
title	Empagliflozin in type 1 diabetes
title_short	Empagliflozin in type 1 diabetes
title_full	Empagliflozin in type 1 diabetes
title_fullStr	Empagliflozin in type 1 diabetes
title_full_unstemmed	Empagliflozin in type 1 diabetes
title_sort	empagliflozin in type 1 diabetes
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/98d3c9d7fe344aa798dd92c4723adf3c
work_keys_str_mv	AT mathieuc empagliflozinintype1diabetes AT vandenmooterl empagliflozinintype1diabetes AT eeckhoutb empagliflozinintype1diabetes
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Empagliflozin in type 1 diabetes

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