Results Show Canagliflozin Reduces "Roller Coaster" Effect in Type 1 Diabetes

The sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin can be used alongside insulin to reduce glycemic variability for patients with type 1 diabetes (T1D), leading to greater treatment satisfaction, according to a study published online Tuesday in Diabetes Care.

Early results were presented in June at the 76th Scientific Sessions of the American Diabetes Association in New Orleans, where the study was described as the largest to date involving an SGLT2 inhibitor for the treatment of T1D. The presenter, senior author Maria Alba, MD, said canagliflozin was able to reduce the “glycemic roller coaster” that many patients with T1D experience throughout the day.

Studies of SGLT2 inhibitors, including canagliflozin, have been going on for some time, as researchers look for ways to resolve unmet medical needs for patients with T1D. Besides the potential to reduce glycemic variability, SGLT2 inhibitors are known to help patients achieve modest weight loss. They also have a mechanism of action independent of other treatments so they can be used with insulin. Right now, SGLT2 inhibitors are only approved to treat type 2 diabetes.

The randomized, double-blind study of 351 patients took place over 18 weeks. Patients received 100 mg or 300 mg of canagliflozin, or placebo. A subset of 89 patients also used continuous glucose monitoring (CGM) to track glycemic variability, in order to see how well their blood glucose stayed in range. Finally, participants were asked to fill out a questionnaire to gauge their level of treatment satisfaction.

Results were as follows:

· At week 18, patients taking canagliflozin had greater reductions in mean glucose than those using the placebo: changes were —1.2 for the 100 mg dose, –0.7 for the 300 mg dose, and 0.6 mmol/L respectively.

· Changes in glucose standard deviation, as measured by the CGM, were —0.3 for the 100 mg dose, –0.7 for the 300 mg dose; and 0.1 mmol/L for the placebo, respectively.

· The canagliflozin doses were associated with increases in time spent in target compared with placebo (11.6% and 10.1%, vs —3.5% for placebo), as well as reductions in time spent above target (–12.7% and –7.6%, vs 5.7% for placebo).

· Study participants said they were more satisfied with treatment on canagliflozin compared with placebo, needed less insulin, and improved their body weight.

Reference

Rodbard HW, Peters Al, Slee A, Cao A, Traina SB, Alba M. The effect of canagliflozin, a sodium glucose cotransporter 2 inhibitor, on glycemic end points assessed by continuous glucose monitoring and patient-reported outcomes among people with type 1 diabetes [published online November 29, 2016]. Diabetes Care. 2016; http://dx.doi.org/10.2337/dc16-1353