Evaluation of the safety of sodium‐glucose co‐transporter‐2 inhibitors for treating patients with type 1 diabetes

Abstract

Introduction Sodium‐glucose cotransporter‐2 (SGLT‐2) inhibitors have been widely used in the treatment of type 2 diabetes mellitus (T2DM) and have been found to achieve good therapeutic results. There is still controversy about SGLT‐2 inhibitors and whether or not they can be effectively used for the treatment of patients with type 1 diabetes mellitus (T1DM). Materials and Methods We searched three databases (Pubmed, Embase, and the Cochrane Library) for randomized controlled trials that treated T1DM by using SGLT‐2 inhibitors from our study inception through March 5, 2020. Results Of the 1653 articles we identified that fit our search criteria, 22 studies included in qualitative‐based results and 8 randomized clinical trials included quantitative‐based results. Compared with the control group, the SGLT‐2 inhibitors treatment group was found to have had an increased incidence of: ketoacidosis (P < 0.00001, OR 4.34, 95% CI [2.37, 7.96], I²=18%), events leading to discontinuation (P < 0.0001, OR 1.76, 95% CI [1.34, 2.31], I²=0%), genital infection (P < 0.00001, OR 3.64, 95% CI [2.82, 4.70], I²=0%), volume depletion (P=0.006, OR 2.10, 95% CI [1.23, 3.59], I²=4%) and diarrhea(P = 0.008, OR 1.64, 95% CI [1.14, 2.36], I²=0%). However, the risk of diarrhea was dose related according to the subgroup analysis. The incidence of: urinary tract infection (UTI), cardiovascular events, renal events, liver injury, and fracture were not significantly different for experimental groups compared to results for the control groups. Conclusions Despite showing some promise as a treatment approach, the application of SGLT‐2 inhibitors for patients afflicted with type 1 diabetes mellitus should be carefully considered.