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Dr Aidin Rawshani

Tablets improved blood sugar (HbA1c) in type 1 diabetes

A new treatment for high blood sugar in people with type 1 diabetes has been approved for use in Europe for people. Zynquista (Sotagliflozin) is an oral tablet that inhibits SGLT-1 and SGLT-2 proteins in the kidneys and intestines, which affects how we absorb sugar (glucose). Treatment with this medicine results in improved diabetes control.

The drug is approved for adults with type 1 diabetes with a body mass index (BMI) 27 kg/m2 who are struggling to control their blood sugar levels. The decision to make the drug available to individuals with type 1 diabetes was based on a series of clinical studies involving about 3000 people.

The results showed that Zynquista contributed to reducing mean blood sugar levels, body weight and blood pressure. Zynquista is a unique medicine because it works by inhibiting two different proteins in different parts of the body. By inhibiting the protein SGLP2, the absorption of blood sugar by the kidneys is reduced while blocking SGLT1 proteins slows the absorption of sugar in the gastrointestinal tract.

Zynquista’s approval in Europe although the US Medicines Agency decided to block the drug because of the increased risk of diabetic ketoacidosis (DKA). Adults with type 1 diabetes who do not achieve adequate glucose control with insulin may be offered Zynquistase or Forxiga (dapagliflozin) which is an SGLT2 inhibitor.

Brief information about the latest article

Most patients with type 1 diabetes do not achieve adequate glucose control with insulin therapy alone. Therefore, scientists and doctors chose to evaluate the safety and efficacy of Sotagliflozin, an oral SGLT1. and SGLT2 inhibitor, in combination with insulin therapy in patients with type 1 diabetes.

How was the question examined?

The research study examined 1402 patients with type 1 diabetes treated with either Sotagliflozine or placebo. Patients were treated with these drugs for 24 weeks. The primary study measure was long-term blood sugar (HbA1c) below 53 mmol/mol, without episodes of severe hypoglycaemia or diabetic ketoacidosis (DKA).

Results from the study

Långtidsblodsocker (HbA1c) vid behandling med canagliflozin och placebo ("sockerpiller"). Som framgår av bilden ovan så lyckades patienter som fick canagliflozin sänka sitt långtidsblodsocker (HbA1c) med cirka 0.8%.

Long-term blood sugar (HbA1c) when treated with Sotagliflozin or placebo (“sugar pill”). As shown in the picture above, patients receiving Sotagliflozin managed to reduce their long-term blood sugar (HbA1c) by approximately 0.8%. Both groups were treated with insulin.

Conclusions

Patients with type 1 diabetes receiving insulin and Sotagliflozin achieved better long-term blood sugar (HbA1c) without increased risk of severe hypoglycaemia but slightly increased risk of diabetes ketoacidosis.

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