Rick, type 1 from Massachusetts, writes: Wil, a lot of attention recently has been devoted to the Pros and Cons of type 2 GLP-1 and SGLT-2 medications being added “off label” as an adjunct therapy for persons with type 1 diabetes. What I haven’t read is whether it’s believed the cardio-protective effects seen with T2s on these meds might also help type 1 tickers. What do we know (or speculate) so far?
Wil@Ask D’Mine answers: We know a fair bit, actually, although as you’ll soon see, it may not be much help to us. But before we get into that, it’s worth relating the story of the discovery of the cardio-protective effects of these two classes of meds.
Following the unexpected discovery during the landmark
Now, I should point out that these drugs are not created equal in this regard. When it comes to the GLPs, studies show
Fascinatingly, in both cases, even though we can see the positive effect, no one is quite sure how the meds help the heart—although some new research suggests they reduce aortic plaque, independent of cholesterol levels or body weight, and also reduce inflammation.
So, all of that said, what do we know specifically about T1 tickers and this pair of T2 meds?
What few studies there are on the use of GLP-1s in T1s have produced conflicting results. While they sure work for lowering blood sugar, the evidence for helping out with the heart is less clear. It is worth mentioning that
Still, there’s not much to go on. Actually, Novo Nordisk—makers of Victoza, one of the leading GLP-1 drugs—decided a few years ago not to seek approval for that drug for type 1s, citing weak evidence for its overall effectiveness in our kind.
By comparison, more is known about SGLT-2 use in T1s, and the drugs seem to carry the same benefit for our hearts as they do for the hearts of others—but at much greater risk in another area. More on that in a minute. But first, just how good are SGLT-2 meds for the ticker?
The latest data suggests that taking an SGLT-2 med can reduce the risk of a “major cardiac event” by a whopping 11%. Various studies, however, show that this benefit is largely seen in people who already have cardiovascular disease (CVD). For folks who don’t yet have heart conditions, it seems to make no real difference in risk.
So perhaps these meds are more cardio-curing than “cardio-protective.”
Of course, virtually all the studies to date are in people with T2, which makes sense as the SGLT-2 meds are approved for treating T2. That said, what
Now, about that additional risk I mentioned: While the SGLT-2s help with blood sugar in T1s, and can help with ailing hearts, they also have an unusual and dangerous side effect for T1s—they lower the blood glucose threshold for diabetic keto acidosis (DKA). That means DKA can set in at lower BG levels, and strike faster, without some of the usual warning signs we expect — sometimes even at only mildly elevated glucose levels.
The FDA has even
That said, a debate session at this year’s American Diabetes Association annual Scientific Sessions, showed that the vast majority of doctors support using SGLT-2s off-label for T1s, despite the risks.
Certainly, if you have CVD, and can afford blood ketone testing (the strips aren’t generally covered by insurance and are roughly twice the cost of glucose test strips at almost two bucks a strip), an SGLT-2 med could be a game-changer.
But if your ticker is ticking just fine for now, and with no evidence (yet) that SGLT-2 meds provide help to a healthy heart, the risk doesn’t seem worth the benefit, IMHO.
Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.