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 by 1.9 +/- 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 by 29% +/- 11%(P < .05), free fatty acids by 74% +/- 32% (P < .05), acetoacetate by 67% +/- 34% (P < .05), and beta-hydroxybutyrate by 254% +/- 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.