EFFECTS OF SGLT2 INHIBITOR INITIATION ON INSULIN-TREATED TYPE 2 DIABETES PATIENTS

Abstract

INTRODUCTIONSodium-glucose co-transporter-2 (SGLT2) inhibitors have revolutionized the management of type 2 diabetes mellitus (T2DM) by enhancing glycaemic control, promoting modest weight loss, and providing proven cardiovascular and renal benefits. The impact of SGLT2 inhibitors on insulin-treated T2DM patients has also been highlighted in major clinical trials. This study examines the effects of SGLT2 inhibitors in insulin-treated T2DM patients in a dedicated diabetes clinic, focusing on HbA1c, insulin dosage and regimen, and weight changes after six months of treatment. METHODOLOGYThis retrospective study was conducted at the diabetes clinic of Hospital Sultan Haji Ahmad Shah. Insulin-treated T2DM patients who were initiated on SGLT2 inhibitors between June and August 2024 were included in the study. Patients on concomitant GLP-1 receptor agonist therapy were excluded. Electronic medical records were reviewed for patient follow-up records. RESULTFifty patients were included in the study, with a mean age of 52.32 years, and a predominance of female patients (64%). 74% of the patients were initiated on empagliflozin. The initiation of SGLT2 inhibitors resulted in a 12% reduction in basal-bolus therapy, with insulin treatment being de-intensified to premixed insulin therapy. There was a modest reduction in total daily dose (TDD) of insulin use (mean reduction 1.12 units, SD 19.4), HbA1c (mean reduction 0.36%, SD 1.8), and weight (mean reduction 1.02 kg, SD 7.5). 34% of patients experienced a reduction in TDD insulin use of more than 5 units, and 66% showed a reduction in HbA1c levels. In the empagliflozin-treated group, there was a greater reduction in TDD insulin and weight, while the dapagliflozin-treated group showed a greater reduction in HbA1c. CONCLUSIONInitiation of SGLT2 inhibitors in insulin-treated T2DM patients has shown promising effects, supporting the initiative for insulin deintensification. However, further exploration and investigation are needed to assess the long-term metabolic effects and durability of SGLT2 inhibitor treatment.