A little pee could go a long way in helping type 1s get their blood sugars in line.
At least that’s what researchers think about the new class of drugs known as SGLT-2 inhibitors, which are designed for use in people with type 2 but are also becoming a potential treatment for type 1s.
Yes, these new sodium-glucose transporter inhibitors could provide an interesting therapy boost for type 1s, even though we aren’t the target audience for them at this point. Research in very early stages is showing promise and could lead to more comprehensive clinical studies. All of this comes at a time when a growing class of SGLT-2 inhibitors is premiering, making a splash in the media with lots of pee-based headlines.
The two on the market in the U.S. so far are Janssen’s Invokana (officially Canagliflozin) that cleared the FDA in March 2013, and Farxiga (aka Dapagliflozin) made by Bristol Myers Squibb and FDA approved in January 2014. And there’s at least one more coming from Eli Lilly, developing Empagliflozin that’s yet to clear the FDA.
Whatever the name, these drugs have a simple job: blocking glucose re-absorption in the kidney through increased urination, which leads to lower glucose levels. They also have the welcome side effect of weight loss, which most other diabetes drugs haven’t offered (with the notable exception of Byetta).
At the moment, only the once-daily pill Invokana is being researched for use with type 1 PWDs. Those who’ve seen this research in action say there’s a lot to look forward to.
Dr. Richard Jackson of Joslin Diabetes Center is one of a few key researchers who’ve been looking at this class of drugs for use in type 1s for the past year. He echoes what others say about the potential for smoothing out post-prandial blood sugars and offering weight loss benefits.
Meanwhile in Toronto, fellow type 1 PWD Dr. Bruce Perkins has also been studying the effects of SGLT-2 inhibitors in type 1 diabetes, and recently published initial research findings in the March edition of the journal Diabetes Care. That pilot study tested Invokana in 40 patients for eight weeks alongside daily insulin doses, and Dr. Perkins says the mean A1C dropped from 8.0% to 7.6% and they saw decreased fasting glucose levels in all participants.
“We were testing the effects on kidneys and had them on CGMs to evaluate blood glucose, and it had a beautiful effect on the kidneys and on A1C, with more steady blood sugars and lost weight,” he said. “The patients had fewer hypos, most likely because they were using less insulin, and so this add-on therapy seems like it could help all of those. My feeling from this proof-of-concept study is that we should push for this research to be done properly and in bigger randomized clinical studies.”
In fact, study participants said they felt “leaner and meaner” using the SGLT-2 inhibitor, and they had less worry about insulin dosing dangers at night, Dr. Perkins reports.
Of course, the hallmark of SGLT-2 therapy is that patients can slough off excess glucose out of the body just by peeing more — but not in the “bad” way that we mean when talking about high blood sugars and ketones.
So it seems like a potential panacea: an “easy” path to eliminating post-meal spikes and losing weight to boot. But guess what? There are drawbacks, too.
One of those who’ve seen type 1 patients using the drug off-label, based on their endo’s recommendations, and even tried it out himself, is type 1 certified diabetes educator Gary Scheiner in Pennsylvania. Gary’s been living with type 1 for decades and says he wanted to try out Invokana personally, along with his patients.
“My personal use was not as good as most of the patients I have using it, and I ended up going off it,” Gary said. “It does what it says it will, and you will urinate away a lot of the glucose in your system. But the problems I experienced with it were running to the bathroom way too much, to the point that I couldn’t get enough sleep, or even couldn’t stand driving long distances or sitting with patients for a long time. Most patients don’t see that, so maybe something about my plumbing is different.”
Gary also said he lost some ability to sense his blood sugar dropping, and thus endured a fair amount of lows that he couldn’t predict.
“It doesn’t matter if you’re at 300 or 50, this drug is still working to lower your blood sugar,” he said. “I have enough lows already with all the exercise and activity that I do, so I didn’t need more of those.”
A big concern for possible side effects from these SGLT-2 inhibitors is the risk of urinary tract infections, which is the most common. But the data isn’t conclusive on that at this time, and the majority of researchers say those using this drug are mostly pleased with the benefits of better blood sugar control and losing weight.
“This is all very early, but (testing it) shows that it’s working and has a lot of potential for type 1s,” Gary said.
We’ll have to see what’s on tap for these SGLT-2 inhibitors when it comes to type 1, and that’s a topic we’ll probably be hearing more about at the upcoming American Diabetes Association’s Scientific Sessions (in San Francisco this year) and beyond.