Study: Triple Therapy Effective for Type 1 Diabetes But Carries Ketosis Risk

Adding dapagliflozin to liraglutide and insulin in patients with type 1 diabetes significantly improves glycemic levels and weight loss but also increases the risk of ketosis, according to the results of a recent trial.

In order to investigate whether dapagliflozin, a sodium-glucose cotransporter-2 inhibitor approved for the treatment of type 2 diabetes, could aid in the treatment of type 1 diabetes, researchers at the State University of New York at Buffalo conducted a randomized clinical trial involving 30 patients, randomly assigned to either dapagliflozin 10 mg or placebo daily for 12 weeks. Of the 30 patients, 26 completed the study.
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Overall, the 17 participants in the dapagliflozin group saw reductions in glycated hemoglobin levels by 0.66% and weight reductions of 1.9 kg, while the 9 participants in the placebo group saw no significant changes.

There were significant increases in plasma concentrations of glucagon, hormone-sensitive lipase, free fatty acids, acetoacetate, and β-hydroxybutyrate, and urinary ketone levels in the dapagliflozin group, and 2 participants in the dapagliflozin group developed ketoacidosis.

“Addition of dapagliflozin to insulin and liraglutide in patients with [type 1 diabetes] results in a significant improvement in glycemia and weight loss while increasing ketosis. If it is decided to use this approach, then it must be used only by a knowledgeable patient along with an endocrinologist who is well versed with it,” the researchers concluded.

—Michael Potts

Reference:

Kuhadiya ND, Ghanim H, Mehta A, et al. Dapagliflozin as additional treatment to liraglutide and insulin in patients with type 1 diabetes [published online August 5, 2016]. J Clin Endocrinol Metab. doi:10.1210/jc.2016-1451.