Research Finds SGLT2 Inhibitors May Yield CV, Renal Benefits in Patients With T1D

Research presented at the American Society of Nephrology Kidney Week 2021 revealed sodium-glucose co-transporter 2 (SGLT 2) inhibitors may provide protective effects to the kidneys and hearts of individuals with type 1 diabetes (T1D).

As SGLT 2 inhibitors have been proven to yield beneficial cardiovascular and renal effects in individuals with type 2 diabetes, investigators from Denmark sought to determine if these benefits are also exhibited in those with T1D. To do so, researchers estimated the risk of cardiovascular disease (CVD) and end-stage kidney disease (ESKD) among patients both receiving and not receiving the treatment.

A total of 3660 adults with T1D were enrolled in the study between 2001 and 2016. All participants were between the ages 30 and 75 years and had an estimate glomerular filtration rate (eGFR) of >45 ml/min/1.73 m2.

To estimate the 5-year cumulative risk of ESKD in the total study population, and the 5- and 10-year cumulative risk of CVD among the 3284 (89.7%) patients without previous CVD at baseline, researchers utilized The Steno Type 1 Risk Engine.

“The effect of SGLT2 [inhibitors] was simulated by changing the recorded [glycated hemoglobin] and systolic blood pressure (SBP) values in accordance with results from the DEPICT studies. Individual absolute change in [glycated hemoglobin] and SBP was simulated as randomly drawn numbers from a normal distribution with mean (SD) of -3.6 (0.9) mmol/mmol and -1.12 (2.8) mmHg,” researchers explained.

In addition, “recorded eGFR and albuminuria were changed in accordance with results from the Tandem studies; no change in eGFR and mean (SD) %-change in albuminuria of -23.7 (12.9).”

Analyses revealed:

• SGLT2 inhibitors induced change in the risk variables translated into an overall 5-year CVD relative risk reduction of 6.1% (95% confidence interval [CI], 5.9-6.3), with up to 11.1% (95% CI, 10-12.2) in the subgroup with albuminuria
• Similar results were seen for the 10-year risk of CVD
• For the estimated 5-year risk of ESKD, overall relative risk reduction was 5.3% (95% CI, 5.1-5.4) with up to 7.6% (95% CI, 6.9-8.4) in the subgroup with albuminuria

“In our study, we have shown significant risk reductions for [CVD] and kidney failure with SGLT2 inhibitor treatment in [T1D],” said study author Elisabeth Stougaard, PhD, of Steno Diabetes Center in Copenhagen. She continued, “our model provides an estimate of benefit that may balance the risks associated with use of SGLT2 inhibitors in [T1D].”

Reference

Stougaard EB, Vistisen D, Persson F, and Rossing P. Sodium-glucose cotransporter 2 inhibitors as adjunct therapy for type 1 diabetes and the benefit on cardiovascular and renal disease evaluated by Steno risk engines. Presented at: Kidney Week; November 4-7, 2021. Virtual. Abstract SA-OR23.