Adjunct canagliflozin improves glycemic variability in type 1 diabetes
medwireNews: Canagliflozin improves glycemic variability and treatment satisfaction in patients with type 1 diabetes using the sodium glucose cotransporter 2 inhibitor as an add-on to insulin, show findings from a randomized trial.
However, study author Helena Rodbard (Endocrine and Metabolic Consultants, Rockville, Maryland, USA) and team stress that “further clinical development must proceed with caution,” because of the increased incidence of ketone-related adverse events previously reported in the trial’s primary findings, along with improvements in glycated hemoglobin levels.
The current results, published in Diabetes Care, show that canagliflozin also improved several measures of glycemic variability during 18 weeks of treatment, in 236 patients with sufficient self-monitored blood glucose data.
The standard deviation of patients’ blood glucose levels fell by 0.9 and 1.0 mmol/L in the canagliflozin 100 and 300 mg groups, respectively, compared with 0.1 mmol/L among those taking placebo. And, in a subset of 89 patients with continuous glucose monitoring data, time spent within target blood glucose range (>3.9 to ≤10.0 mmol/L) rose by 11.6% and 10.1% with the 100 and 300 mg canagliflozin doses, respectively, compared with a 3.5% reduction in the placebo group.
This was mostly down to a reduction in time spent above target, by 12.7% and 7.6% in the canagliflozin 100 and 300 mg groups, respectively, compared with a 5.7% increase in the placebo group. There was little change in time spent below target in any of the groups.
“[O]ne of the major challenges in the treatment of type 1 diabetes is to achieve patient-specific glycemic control while avoiding hyperglycemia and hypoglycemia episodes,” say the researchers. They note that, in addition to reducing the risk of dangerous hypoglycemic episodes, controlling glycemic variability may also reduce patients’ risk for developing complications such as peripheral neuropathy.
Canagliflozin was also associated with improved patient satisfaction, significantly more so than placebo, despite the patients being unaware of their treatment allocation. The team found that 21% of the change in treatment satisfaction was accounted for by change in bodyweight, 9% by change in glucose variability, and 4% by change in insulin dose.
Patients taking canagliflozin reported a reduction in the proportion of time they perceived themselves to be in hyperglycemia, relative to those taking placebo, suggesting “that the magnitude of improvement in glycemic control with canagliflozin treatment may be large enough to be both noticeable and meaningful to people with type 1 diabetes.”
They believe that these clear benefits to patients may, in turn, “contribute to improved treatment adherence and performance of self-care behaviors and therefore to better long-term outcomes.”
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