SGLT-2 Inhibitors in Type 1 Diabetes Mellitus: A Comprehensive Review of the Literature

Background: Sodium-Glucose Cotransporter 2 (SGTL-2) inhibitors are a new class of antidiabetics, which have been approved for the treatment of patients with Type 2 Diabetes Mellitus (T2DM). Besides their beneficial metabolic effects, they exert favourable results in cardiovascular events and risk factors along with renoprotection. However, SGLT-2 inhibitors have not been yet approved as an adjunct therapy to insulin in patients with Type 1 Diabetes Mellitus (T1DM). This review aims at presenting both clinical and experimental data that reinforce the role of SGLT-2 inhibitors as adjunctive treatment in patients with T1DM along with the main restrictions of their use, namely Diabetic Ketoacidosis (DKA). Methods: We conducted a comprehensive research of the relevant literature regarding the off-label use of SGLT-2 inhibitors in clinical practice, presenting the major benefits and the potential risks. Results: SGLT-2 inhibitors are associated with improved glycemic control, reduction in body weight, and decrease in insulin dosage, along with their beneficial cardiovascular and renal effects. However, we cannot overlook the association with increased incidence of DKA events, in the presence of well known predisposing factors. Further investigation is required, in order to establish them as adjunctive treatment in those patients. Conclusion: This novel class of antidiabetics seems to be a very attractive treatment option in patients with T1DM, due to their multiple beneficial effects, but the increased risk of DKA should be taken into account.