Sodium‐glucose co‐transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: The STOP DKA Protocol
Abstract
Recent phase 3 clinical trials have evaluated the impact of adding sodium-glucose co-transporter (SGLT) inhibitors to the type 1 diabetes armamentarium. These trials studied SGLT2 inhibitors (dapagliflozin and empagliflozin) and a dual SGLT1 and SGLT2 inhibitor (sotagliflozin), and demonstrated that these oral non-insulin antihyperglycaemic medications are able not only to improve glycaemic control, but also to reduce body weight and extend time in range without increasing rates of hypoglycaemia in type 1 diabetes. Diabetic ketoacidosis (DKA) is a feature of type 1 diabetes and the risk is increased when SGLT inhibitors are used in type 1 diabetes. To minimize the risk of DKA and still gain the multiple benefits, we developed the "STOP DKA Protocol ", an easily accessible and practical tool, that provides a risk mitigation strategy for reducing DKA in patients with type 1 diabetes being treated with SGLT inhibitors.
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Adjunctive use of SGLT inhibitors in adults with type 1 diabetes increases the risk of DKA by an absolute rate of about 4% per year.
“Adjunctive use of sodium-glucose cotransporter (SGLT) inhibitors (see below) in adults with type 1 diabetes increases the risk of DKA by an absolute rate of about 4% per year, suggesting the need for intensive diabetes self-management education and monitoring (216,217).”
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- Authors
- Goldenberg, R. M., Gilbert, J. D., Hramiak, I. M., Woo, V. C., & Zinman, B.
- Affiliations
- LMC Diabetes & Endocrinology (Canada) (CA)
- Sunnybrook Health Science Centre (CA)
- Western University (CA)
- Health Sciences Centre (CA)
- Mount Sinai Hospital (CA)
- Corresponding author
- Goldenberg, Ronald M.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2019-06-30
- Volume
- 21
- Issue
- 10
- Pages
- 2192-2202
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2950136952
- Cited by
- 114
- References
- 4
- Citations by year
- 2026: 10 · 2025: 22 · 2024: 10 · 2023: 11 · 2022: 12 · 2021: 19 · 2020: 23 · 2019: 6
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AstraZeneca
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, diabetic ketoacidosis, SGLT2 inhibitors, dapagliflozin, empagliflozin, sotagliflozin, glycemic control, time in range, hypoglycemia, weight loss
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Benzhydryl Compounds, Diabetes Mellitus, Type 1, Glucosides, Humans, Randomized Controlled Trials as Topic, Diabetic Ketoacidosis, Clinical Trials, Phase III as Topic
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