Sakai Chinatsu, Tamaru Shinichi, Sugai Keiji, Takeuchi Hironori, Suzuki Ryo
Department of Pharmacy, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo, Japan.
J Diabetes Investig. 2025 Aug;16(8):1420-1429. doi: 10.1111/jdi.70085. Epub 2025 May 26.
This study aimed to evaluate the factors contributing to insulin dosage adjustment and the risk of sodium-glucose cotransporter-2 inhibitor (SGLT2i) discontinuation in persons with type 1 diabetes mellitus (T1DM) starting SGLT2i therapy in clinical practice.
This retrospective study used the electronic medical record-based survey data of 49 patients attending our hospital between December 2018 and October 2021 to investigate the clinical use and adverse effects of SGLT2i in persons with T1DM starting SGLT2i.
Upon SGLT2i initiation, there were five patients in the favorable glycemic control group (HbA1c < 7.5%) and 44 patients in the poor glycemic control group (HbA1c ≥ 7.5%); few patients in the favorable glycemic control group reduced total daily insulin dose according to the recommendation, while 75% of patients in the group with poor glycemic control followed the guideline. Moreover, 60% of patients had hypoglycemia before the introduction of SGLT2i; additionally, among patients with no hypoglycemia before introduction, 50% had hypoglycemia after introduction. The group with hypoglycemia after induction tended to have longer diabetes duration and lighter body weight compared to the group without hypoglycemia. Multiple regression analysis revealed that diuretic use was an independent risk factor for discontinuation of SGLT2i (partial regression coefficient = 0.819, P = 0.001).
When initiating SGLT2i in T1DM patients, it is important to evaluate glycemic control and adjust insulin dosage based on weight and diabetes duration to reduce hypoglycemia frequency.
本研究旨在评估在临床实践中开始使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）治疗的1型糖尿病（T1DM）患者中，胰岛素剂量调整的影响因素以及SGLT2i停药风险。
本回顾性研究使用了2018年12月至2021年10月期间在我院就诊的49例患者基于电子病历的调查数据，以调查SGLT2i在开始使用SGLT2i的T1DM患者中的临床应用及不良反应。
开始使用SGLT2i时，血糖控制良好组（糖化血红蛋白<7.5%）有5例患者，血糖控制不佳组（糖化血红蛋白≥7.5%）有44例患者；血糖控制良好组中很少有患者按照建议减少每日胰岛素总剂量，而血糖控制不佳组中有75%的患者遵循了指南。此外，60%的患者在开始使用SGLT2i之前有低血糖；另外，在开始使用前无低血糖的患者中，50%在开始使用后出现低血糖。与无低血糖组相比，诱导后出现低血糖的组糖尿病病程往往更长，体重更轻。多元回归分析显示，使用利尿剂是SGLT2i停药的独立危险因素（偏回归系数=0.819，P=0.001）。
在T1DM患者中开始使用SGLT2i时，评估血糖控制情况并根据体重和糖尿病病程调整胰岛素剂量以降低低血糖发生频率非常重要。
