e-learning | Sotagliflozin with insulin for Type 1 diabetes

This is a new guideline from NICE published in Feb 2020 advising that Sotagliflozin can be used alongside insulin for Type 1 diabetes.

Sotagliflozin is an SGLT1 and SGLT2 inhibitor. It is only licensed for Type 1 diabetes, not for Type 2 diabetes.

Dapagliflozin was endorsed by NICE in Aug 19 as a treatment for Type 1 diabetes. Satagliflozin has exactly the same restrictions on it's use. It improves HbA1c, brings greater weight loss and improves quality of life. It is presumed that this drop in HbA1c will lead to a lower risk of complications from diabetes, though this hasn't yet been shown.

Both increase the risk of ketoacidosis and both need to be stopped if there is a sustained fall in GFR to < 45.

Who can have Sotagliflozin?

Patients who already have an optimised insulin regime and who still do not have adequate glycaemic control can have Satagliflozin if:

  • they have a BMI of 27 or more AND
  • they are on insulin doses of at least 0.5 units / kg / day AND
  • they have completed a structured educational course about ketoacidosis AND
  • treatment is started and supervised by a specialist AND
  • GFR is 60 or more on starting.

What monitoring should patients have and how long should Satagliflozin be used for?

HbA1c should be checked at 6m and then regularly thereafter.

It should be stopped if there hasn't been a sustained improvement in HbA1c of 0.3% or 3 mmol/mol.

It should be stopped if there is a sustained fall in GFR to 45 or less.

As with dapagliflozin, the benefits from Satagliflozin seem to be time limited. After 2 years, the HbA1c seems to return to baseline.

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