SGLT2抑制剂对1型糖尿病患者持续皮下胰岛素输注的有效性和安全性:一项真实世界的研究

Q3 Medicine Endocrine regulations Pub Date : 2023-01-01 DOI:10.2478/enr-2023-0018

Vania Benido Silva, Liliana Fonseca, Diana Borges Duarte, Francisca Marques Puga, Guilherme Assuncao, Susana Garrido, Sofia Teixeira, Joana Vilaverde, Maria Helena Cardoso

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引用次数: 1

摘要

目标。钠-葡萄糖共转运2抑制剂(SGLT2i)辅助治疗1型糖尿病(T1D)与血糖控制改善相关，但增加了糖尿病酮症酸中毒(DKA)的风险。然而，对T1D患者持续皮下胰岛素输注(CSII)的现实研究仍然很少。我们提出了第一个在接受CSII治疗的T1D患者中进行的现实研究。本研究的目的是评估SGLT2i对CSII下T1D患者的代谢影响和安全性。方法。回顾性研究包括34名CSII下的T1D成人，他们在2021年6月30日之前开始SGLT2i。收集SGLT2i引入时、使用3、6、12个月后的血糖控制和急性糖尿病并发症数据。结果。23人被纳入研究。与使用3、6、12个月后引入SGLT2i的时刻相比，TIR(∆T3M=12.8%;∆T6M = 11.5%;∆T12M=11.1%)，且随时间的增加而下降(∆T3M=13.6%;∆T6M = 11.9%;∆T12M = 10.5%)。在此范围内，时间上无显著差异。平均血糖和平均血糖管理指标在3个评估时刻均显著降低。中位体重也显著降低(∆T6M=2 kg;∆T12M = 4.5公斤)。2例患者(8.7%)在SGLT2i治疗期间出现轻度正血糖性DKA，均为女性，体重指数(BMI) 2。其中一名患者在使用3个月后每日胰岛素总剂量(TDDI)降低26.9%。结论。使用SGLT2i作为CSII下T1D患者的辅助治疗，与TIR的显著增加相关，而不增加低血糖的时间。它也有减肥的好处。在选定的参与者中谨慎使用是必要的，以减少DKA的发生。

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Efficacy and safety of SGLT2 inhibitors in individuals with type 1 diabetes under continuous subcutaneous insulin infusion: a real-world study.

Objective. Adjuvant therapy with sodium-glucose cotransport 2 inhibitors (SGLT2i) in type 1 diabetes (T1D) is associated with an improvement in glycemic control, but increases the risk of diabetic ketoacidosis (DKA). However, real-life studies in individuals with T1D under continuous subcutaneous insulin infusion (CSII) are still scarce. We present the first real-life study performed in patients with T1D exclusively treated with CSII. The aim of the present study was to assess the metabolic impact and safety of SGLT2i in T1D individuals under CSII. Methods. Retrospective study includes 34 T1D adult individuals under CSII, who started SGLT2i until 30th June 2021. Data regarding the glycemic control and acute diabetes complications at the moment of introduction of SGLT2i and after 3, 6, and 12 months of use were collected. Results. Twenty-three individuals were included. Comparing with the moment of SGLT2i introduction after 3, 6, and 12 months of use, there was a statistically significant increase of time in range (TIR) (∆_T3M=12.8%; ∆_T6M=11.5%; ∆_T12M=11.1%), and a decrease in time above range (∆_T3M=13.6%; ∆T6M=11.9%; ∆_T12M=10.5%). There were no significant differences in time below the range. Mean glucose and mean glucose management indicator significantly reduced in the 3 evaluated moments. A significant reduction in median weight was also observed (∆_T6M=2 kg; ∆_T12M=4.5 kg). Two patients (8.7%) developed mild euglycemic DKA during SGLT2i treatment, both were women and had body mass index (BMI) <27 kg/m². One of them had a total daily insulin dose (TDDI) reduction of 26.9% after 3 months of use. Conclusions. The use of SGLT2i, as an adjuvant treatment in T1D individuals under CSII, was associated with a significant increase of TIR without increasing time in hypoglycemia. It also had a weight benefit. Careful use in selected participants is necessary to reduce the occurrence of DKA.