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J Clin Endocrinol Metab. 2016 Sep;101(9):3506-15. doi: 10.1210/jc.2016-1451. Epub 2016 Aug 4.

Dapagliflozin as Additional Treatment to Liraglutide and Insulin in Patients With Type 1 Diabetes.

Author information

1
Division of Endocrinology, Diabetes, and Metabolism, State University of New York at Buffalo, Buffalo, New York 14215.

Abstract

CONTEXT:

It is imperative that novel approaches to treatment of type 1 diabetes (T1D) are devised.

OBJECTIVE:

The objective of the study was to investigate whether addition of dapagliflozin to insulin and liraglutide results in a significant reduction in glycemia and body weight.

DESIGN:

This was a randomized clinical trial.

SETTING:

The study was conducted at a single academic medical center.

PARTICIPANTS:

Participants included T1D patients on liraglutide therapy for at least last 6 months.

INTERVENTION:

Thirty T1D patients were randomized (in 2:1 ratio) to receive either dapagliflozin 10 mg or placebo daily for 12 weeks.

MAIN OUTCOME MEASURE:

Change in mean glycated hemoglobin after 12 weeks of dapagliflozin when compared with placebo was measured.

RESULTS:

In the dapagliflozin group, glycated hemoglobin fell by 0.66% ± 0.08% from 7.8% ± 0.21% (P < .01 vs placebo), whereas it did not change significantly in the placebo group from 7.40% ± 0.20% to 7.30% ± 0.20%. The body weight fell by1.9 ± 0.54kg (P < .05 vs placebo). There was no additional hypoglycemia (blood glucose < 3.88 mmol/L; P = .52 vs placebo). In the dapagliflozin group, there were significant increases in the plasma concentrations of glucagon by 35% ± 13% (P < .05), hormone-sensitive lipase by 29% ± 11% (P < .05), free fatty acids by 74% ± 32% (P < .05), acetoacetate by 67% ± 34% (P < .05), and β-hydroxybutyrate by 254% ± 81% (P < .05). Urinary ketone levels also increased significantly (P < .05). None of these changes was observed in the placebo group. Two patients in the dapagliflozin group developed diabetic ketoacidosis.

CONCLUSIONS:

Addition of dapagliflozin to insulin and liraglutide in patients with T1D 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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02518945.

PMID:
27490915
DOI:
10.1210/jc.2016-1451
[Indexed for MEDLINE]

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