SGLT2 Inhibitors for Type 1 Diabetes Mellitus

Current Regulatory Status and Recommendations

• SGLT2 inhibitors are FDA-approved for type 2 diabetes but not for type 1 diabetes in the United States, according to the American Diabetes Association Standards of Care 2, 3

Risks Associated with SGLT2 Inhibitor Use in Type 1 Diabetes

• The FDA issued a specific warning about the risk of euglycemic diabetic ketoacidosis (DKA) in patients with type 1 diabetes treated with SGLT2 inhibitors, with a risk 5-17 times higher than in people with T1D not treated with these agents 2, 3
• SGLT2 inhibitor-associated DKA occurs in approximately 4% of people with type 1 diabetes 1
• Euglycemic DKA can occur with normal or only slightly elevated blood glucose levels, making it harder to detect 1

Risk Factors for DKA in Patients with Type 1 Diabetes on SGLT2 Inhibitors

• Very low-carbohydrate diets, prolonged fasting, and dehydration increase the risk of DKA in patients with type 1 diabetes on SGLT2 inhibitors 1
• Excessive alcohol intake is a risk factor for DKA in patients with type 1 diabetes on SGLT2 inhibitors 1, 4
• Volume depletion is a risk factor for DKA in patients with type 1 diabetes on SGLT2 inhibitors 4

Clinical Implications and Recommendations

• Patients who have previously experienced DKA should not be treated with SGLT2 inhibitors, as recommended by the American Diabetes Association 1

Warning Signs and Monitoring

• Ketone monitoring is essential, as DKA can occur even with blood glucose levels <200 mg/dL, and patients should be educated about symptoms of DKA including nausea, vomiting, abdominal pain, tiredness, and trouble breathing 1