Sodium/glucose cotransporter 2 inhibitors for the treatment of type 1 diabetes: what are the latest developments?

Expert Opin Pharmacother. 2021 Nov;22(16):2261-2266. doi: 10.1080/14656566.2021.1967931. Epub 2021 Aug 20.


Despite the improvements in insulin therapy, many patients with type 1 diabetes mellitus (T1DM) do not achieve glycemic targets. Hypoglycemia and weight gain are important barriers in reaching these targets. Sodium/glucose cotransporter 2 (SGLT2) inhibitors lack these side effects and have an insulin-independent mechanism of action. Therefore, they might be useful in patients with T1DM. The authors discuss the safety and efficacy of SGLT2 inhibitors in T1DM. Several randomized controlled trials have evaluated dapagliflozin, sotagliflozin and empagliflozin in this population whereas fewer data are available for other members of this class. In these studies, SGLT2 inhibitors reduced HbA1c levels and body weight without a greater risk of hypoglycemia. However, a higher incidence of diabetic ketoacidosis (DKA) was observed in patients treated with these agents. SGLT2 inhibitors improve glycemic control in patients with T1DM but this effect is modest. Even though weight loss and the neutral effect on the incidence of hypoglycemia are advantages of these agents, the increased risk of DKA is a cause of concern. Overall, SGLT2 inhibitors should be used with caution and only in carefully selected patients with T1DM who are motivated, adherent to treatment, well-trained in recognizing DKA and are closely followed-up.

Keywords: Canagliflozin; dapagliflozin; diabetic ketoacidosis; empagliflozin; hypoglycemia; sodium/glucose cotransporter 2 inhibitors; sotagliflozin; type 1 diabetes mellitus.

MeSH terms

  • Benzhydryl Compounds / adverse effects
  • Blood Glucose
  • Diabetes Mellitus, Type 1* / drug therapy
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Sodium
  • Sodium-Glucose Transporter 2 Inhibitors*


  • Benzhydryl Compounds
  • Blood Glucose
  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Sodium