AACE MENA 2025-SGLT2i Use in Type 1 DM

Video Transcription

Video Summary

The talk discusses the use of SGLT2 inhibitors as adjunct therapy in type 1 diabetes (T1D), highlighting that T1D is a heterogeneous disease with varying phenotypes, often complicated by obesity, cardiovascular, and renal issues. SGLT2 inhibitors reduce renal glucose reabsorption, lowering HbA1c, insulin doses, weight, and glycemic variability. Despite modest HbA1c reductions (0.3-0.5%) and weight loss (3-5%), their use is limited by increased diabetic ketoacidosis (DKA) risk, requiring careful patient selection, education, and strict ketone monitoring. Approved for type 2 diabetes, SGLT2 inhibitors remain off-label for T1D, with ongoing trials focused on improving safety profiles. Ideal candidates are educated, higher BMI patients using insulin pumps or closed loops, without DKA history or contraindications like pregnancy or low-carb diets. Emphasis is placed on individualized care, monitoring, and risk management to leverage metabolic benefits while mitigating DKA risks. The presenter calls for continued research and cautious off-label use in well-monitored patients.

Keywords

SGLT2 inhibitors

type 1 diabetes

diabetic ketoacidosis

adjunct therapy

glycemic control