SUN-519 - Real-World Efficacy and Safety of Sodium-Glucose Cotransport 2 Inhibitors in Type 1 Diabetes

Introduction: Real-world evidence on sodium-glucose cotransporter 2 inhibitors (SGLT2i) as an add-on therapy in type 1 diabetes (T1DM) is limited. These drugs may provide benefits, but there are concerns about safety, especially diabetic ketoacidosis (DKA).

Methods: Retrospective analysis of adults with T1DM prescribed SGLT2i (empagliflozin, dapagliflozin, bexagliflozin) with available continuous glucose meter (CGM) data at a university institute (2018-2025). The primary outcome was the change in CGM-derived Time-in-Range (TIR, 70-180 mg/dL) from baseline to 3-month follow-up. Secondary outcomes included changes in Time Above/Below Range (TAR/TBR), insulin dosing, incidence of DKA and treatment persistence.

Results: Of 20 eligible patients prescribed an SGLT2i, 18 started therapy. Of these, 14 were included in the efficacy group (mean age 39.2±13.2 years, 92.9% pump users, baseline TIR 57.4±22.8%). At follow-up, mean TIR increased by 13.5% (to 70.9±17.6%; p=0.13), mainly due to a 12.5% drop in TAR (p=0.14). TBR showed no change (p=0.43). Clinically, 64.3% improved TIR by more than 5%. Total daily insulin fell by 12.9% (p=0.40, n=12) and basal insulin by 4.25% (p=0.33, n=13). In patients with baseline TIR under 60% (n=7), TIR rose by 19.6% (p=0.078). Of the patients who initiated therapy (n=18), the mean duration of SGLT2i use was 2.2 years, with 50% continuing for more than 1.5 years. One DKA event (5.0%) occurred due to insulin pump failure.

Conclusion: Adjunctive SGLT2i therapy in T1DM demonstrated clinically meaningful improvements in TIR and insulin reduction, particularly for patients with poorer baseline control. However, despite these trends, the results were not statistically significant. Larger, prospective studies with longer follow-up are required to define the long-term risk-benefit profile.

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