Dapagliflozin as additional treatment to liraglutide and insulin in patients with type 1 diabetes

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 by29%±11%(P<.05), free fatty acids by 74%±32% (P<.05), acetoacetate by67%±34%(P<.05), and β-hydroxybutyrate by254%±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.