Cardiorenal Outcomes With SGLT2i Prescription in T1D

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated cardiorenal benefits in individuals with chronic kidney disease (CKD) and type 2 diabetes. They are also approved in Europe for use in patients with type 1 diabetes (T1D) but are not yet approved for that purpose by the US Food and Drug Administration.

Mariangel Goitia and others conducted a retrospective study to determine whether SGLT2is have an association with cardiorenal benefits for patients with T1D. Their findings were presented during the National Kidney Foundation Spring Clinical Meetings.

Their study included 4114 patients with T1D seen at the Joslin Diabetes Center in Boston, Massachusetts, between January 2015 and December 2022; 39% had been prescribed an SGLT2i. Mean (SD) patient age was 44.0 (16.1) years, and duration of diabetes was 30.2 (14.2) years. The majority of subjects were White (88%), 51% were female, and 31% had CKD.

The average estimated glomerular filtration rate (eGFR) was 108.1 (13.8), and the median urine albumin-to-creatine ratio was 12.4 (interquartile range, 6.3-26.5). Those receiving an SGLT2i were younger (41.3 [15.8] vs 45.8 [16.0] years; P<.001). They also had higher eGFR (111.4 [13.9] vs 106.9 [13.7]; P<.001), higher serum albumin (4.21 [0.30] vs 4.16 [0.29]; P<.01), higher hemoglobin (13.80 [1.48] vs 13.60 [1.50]; P=.4), and lower diabetes duration (27.1 [12.2] vs 32.2 [15.1]; P<.001). HbA1c and CKD did not vary between the two groups.

The research team used multivariable logistic regression to determine that albumin (odds ratio [OR], 1.64 [95% CI, 1.11-2.44]; P=.01), duration of T1D (OR, 0.98 [0.97-0.99]; P<.001]), and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (OR, 0.55 [0.44-0.69]; P<.001]) were associated with patients with T1D having a prescription for an SGLT2i.

In sum, the researcher determined that being prescribed an SGLT2i with T1D does not seem to be associated with CKD diagnosis or HbA1c control.

For more on this topic, watch our video of Mariangel Goitia discussing her presentation.

Source: Goitia M, Almanzar D, Rosas S. Factors associated with prescription of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in individuals living with type 1 diabetes (T1D). Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.