@article{anson_sglt2i_2023,
	title = {{SGLT2i} and {GLP}-1 {RA} therapy in type 1 diabetes and reno-vascular outcomes: a real-world study},
	volume = {66},
	issn = {0012-186X, 1432-0428},
	shorttitle = {{SGLT2i} and {GLP}-1 {RA} therapy in type 1 diabetes and reno-vascular outcomes},
	url = {https://link.springer.com/10.1007/s00125-023-05975-8},
	doi = {10.1007/s00125-023-05975-8},
	abstract = {Abstract
            
              Aims/hypothesis
              Insulin is the primary treatment for type 1 diabetes. However, alternative glucose-lowering therapies are used adjunctively, but importantly are off-label in type 1 diabetes. Little work has previously been undertaken to evaluate safety with long-term efficacy and cardio-renal benefits of such therapies. We sought to investigate the real-world impact of sodium–glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with type 1 diabetes in relation to effect on blood glucose levels, adverse events and cardio-renal outcomes.
            
            
              Methods
              We performed a retrospective cohort study of all patients aged 18 or over with type 1 diabetes on the TriNetX platform, a global collaborative network providing access to real-time, anonymised medical records. We included patients who had been treated with an SGLT2i or GLP-1 RA for at least 6 months and analysed the efficacy, safety and cardio-renal outcomes 5 years after initiation of therapy.
            
            
              Results
              
                We identified 196,691 individuals with type 1 diabetes, 13\% of whom were treated with adjunctive glucose-lowering therapy in addition to insulin. Included in the core analysis were 1822 patients treated with a GLP-1 RA and 992 individuals treated with an SGLT2i. Both agents provided clinically meaningful reductions in HbA
                1c
                (−2.6 mmol/mol [−0.2\%] with SGLT2i and −5.4 mmol/mol [−0.5\%] with GLP-1 RA). The SGLT2i treated cohort showed preservation of eGFR over a 5-year period compared with the GLP-1 RA treated cohort (+3.5 ml/min per 1.73 m
                2
                vs −7.2 ml/min per 1.73 m
                2
                , respectively), including patients with established chronic kidney disease (CKD). The SGLT2i treated cohort experienced higher rates of diabetic ketoacidosis (DKA) (RR 2.08 [95\% CI 1.05, 4.12]
                p
                =0.0309) and urinary tract infection/pyelonephritis (RR 2.27 [95\% CI 1.12, 4.55]
                p
                =0.019) compared with the GLP-1 RA treated cohort. However, the SGLT2i treated cohort were less likely to develop heart failure (RR 0.44 [95\% CI 0.23, 0.83]
                p
                =0.0092), CKD (RR 0.49 [95\% CI 0.28, 0.86]
                p
                =0.0118) and be hospitalised for any cause (RR 0.59 [95\% CI 0.46, 0.76]
                p≤
                0.0001) when compared with the GLP-1 RA treated cohort.
              
            
            
              Conclusions/interpretation
              Both SGLT2is and GLP-1 RAs have potential benefits as adjunctive agents in type 1 diabetes. SGLT2is provide cardio-renal benefits, despite an increase in the risk of DKA and urinary tract infection compared with GLP-1 RA therapy. Long-term evaluation of the efficacy and safety of these adjunctive therapies is required to guide their use in individuals with type 1 diabetes.
            
            
              Graphical Abstract},
	language = {en},
	number = {10},
	urldate = {2024-06-04},
	journal = {Diabetologia},
	author = {Anson, Matthew and Zhao, Sizheng S. and Austin, Philip and Ibarburu, Gema H. and Malik, Rayaz A. and Alam, Uazman},
	month = oct,
	year = {2023},
	pages = {1869--1881},
}

{"_id":"RM2QfGCbcPKP6SwHn","bibbaseid":"anson-zhao-austin-ibarburu-malik-alam-sglt2iandglp1ratherapyintype1diabetesandrenovascularoutcomesarealworldstudy-2023","author_short":["Anson, M.","Zhao, S. S.","Austin, P.","Ibarburu, G. H.","Malik, R. A.","Alam, U."],"bibdata":{"bibtype":"article","type":"article","title":"SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes: a real-world study","volume":"66","issn":"0012-186X, 1432-0428","shorttitle":"SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes","url":"https://link.springer.com/10.1007/s00125-023-05975-8","doi":"10.1007/s00125-023-05975-8","abstract":"Abstract Aims/hypothesis Insulin is the primary treatment for type 1 diabetes. However, alternative glucose-lowering therapies are used adjunctively, but importantly are off-label in type 1 diabetes. Little work has previously been undertaken to evaluate safety with long-term efficacy and cardio-renal benefits of such therapies. We sought to investigate the real-world impact of sodium–glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with type 1 diabetes in relation to effect on blood glucose levels, adverse events and cardio-renal outcomes. Methods We performed a retrospective cohort study of all patients aged 18 or over with type 1 diabetes on the TriNetX platform, a global collaborative network providing access to real-time, anonymised medical records. We included patients who had been treated with an SGLT2i or GLP-1 RA for at least 6 months and analysed the efficacy, safety and cardio-renal outcomes 5 years after initiation of therapy. Results We identified 196,691 individuals with type 1 diabetes, 13% of whom were treated with adjunctive glucose-lowering therapy in addition to insulin. Included in the core analysis were 1822 patients treated with a GLP-1 RA and 992 individuals treated with an SGLT2i. Both agents provided clinically meaningful reductions in HbA 1c (−2.6 mmol/mol [−0.2%] with SGLT2i and −5.4 mmol/mol [−0.5%] with GLP-1 RA). The SGLT2i treated cohort showed preservation of eGFR over a 5-year period compared with the GLP-1 RA treated cohort (+3.5 ml/min per 1.73 m 2 vs −7.2 ml/min per 1.73 m 2 , respectively), including patients with established chronic kidney disease (CKD). The SGLT2i treated cohort experienced higher rates of diabetic ketoacidosis (DKA) (RR 2.08 [95% CI 1.05, 4.12] p =0.0309) and urinary tract infection/pyelonephritis (RR 2.27 [95% CI 1.12, 4.55] p =0.019) compared with the GLP-1 RA treated cohort. However, the SGLT2i treated cohort were less likely to develop heart failure (RR 0.44 [95% CI 0.23, 0.83] p =0.0092), CKD (RR 0.49 [95% CI 0.28, 0.86] p =0.0118) and be hospitalised for any cause (RR 0.59 [95% CI 0.46, 0.76] p≤ 0.0001) when compared with the GLP-1 RA treated cohort. Conclusions/interpretation Both SGLT2is and GLP-1 RAs have potential benefits as adjunctive agents in type 1 diabetes. SGLT2is provide cardio-renal benefits, despite an increase in the risk of DKA and urinary tract infection compared with GLP-1 RA therapy. Long-term evaluation of the efficacy and safety of these adjunctive therapies is required to guide their use in individuals with type 1 diabetes. Graphical Abstract","language":"en","number":"10","urldate":"2024-06-04","journal":"Diabetologia","author":[{"propositions":[],"lastnames":["Anson"],"firstnames":["Matthew"],"suffixes":[]},{"propositions":[],"lastnames":["Zhao"],"firstnames":["Sizheng","S."],"suffixes":[]},{"propositions":[],"lastnames":["Austin"],"firstnames":["Philip"],"suffixes":[]},{"propositions":[],"lastnames":["Ibarburu"],"firstnames":["Gema","H."],"suffixes":[]},{"propositions":[],"lastnames":["Malik"],"firstnames":["Rayaz","A."],"suffixes":[]},{"propositions":[],"lastnames":["Alam"],"firstnames":["Uazman"],"suffixes":[]}],"month":"October","year":"2023","pages":"1869–1881","bibtex":"@article{anson_sglt2i_2023,\n\ttitle = {{SGLT2i} and {GLP}-1 {RA} therapy in type 1 diabetes and reno-vascular outcomes: a real-world study},\n\tvolume = {66},\n\tissn = {0012-186X, 1432-0428},\n\tshorttitle = {{SGLT2i} and {GLP}-1 {RA} therapy in type 1 diabetes and reno-vascular outcomes},\n\turl = {https://link.springer.com/10.1007/s00125-023-05975-8},\n\tdoi = {10.1007/s00125-023-05975-8},\n\tabstract = {Abstract\n \n Aims/hypothesis\n Insulin is the primary treatment for type 1 diabetes. However, alternative glucose-lowering therapies are used adjunctively, but importantly are off-label in type 1 diabetes. Little work has previously been undertaken to evaluate safety with long-term efficacy and cardio-renal benefits of such therapies. We sought to investigate the real-world impact of sodium–glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with type 1 diabetes in relation to effect on blood glucose levels, adverse events and cardio-renal outcomes.\n \n \n Methods\n We performed a retrospective cohort study of all patients aged 18 or over with type 1 diabetes on the TriNetX platform, a global collaborative network providing access to real-time, anonymised medical records. We included patients who had been treated with an SGLT2i or GLP-1 RA for at least 6 months and analysed the efficacy, safety and cardio-renal outcomes 5 years after initiation of therapy.\n \n \n Results\n \n We identified 196,691 individuals with type 1 diabetes, 13\\% of whom were treated with adjunctive glucose-lowering therapy in addition to insulin. Included in the core analysis were 1822 patients treated with a GLP-1 RA and 992 individuals treated with an SGLT2i. Both agents provided clinically meaningful reductions in HbA\n 1c\n (−2.6 mmol/mol [−0.2\\%] with SGLT2i and −5.4 mmol/mol [−0.5\\%] with GLP-1 RA). The SGLT2i treated cohort showed preservation of eGFR over a 5-year period compared with the GLP-1 RA treated cohort (+3.5 ml/min per 1.73 m\n 2\n vs −7.2 ml/min per 1.73 m\n 2\n , respectively), including patients with established chronic kidney disease (CKD). The SGLT2i treated cohort experienced higher rates of diabetic ketoacidosis (DKA) (RR 2.08 [95\\% CI 1.05, 4.12]\n p\n =0.0309) and urinary tract infection/pyelonephritis (RR 2.27 [95\\% CI 1.12, 4.55]\n p\n =0.019) compared with the GLP-1 RA treated cohort. However, the SGLT2i treated cohort were less likely to develop heart failure (RR 0.44 [95\\% CI 0.23, 0.83]\n p\n =0.0092), CKD (RR 0.49 [95\\% CI 0.28, 0.86]\n p\n =0.0118) and be hospitalised for any cause (RR 0.59 [95\\% CI 0.46, 0.76]\n p≤\n 0.0001) when compared with the GLP-1 RA treated cohort.\n \n \n \n Conclusions/interpretation\n Both SGLT2is and GLP-1 RAs have potential benefits as adjunctive agents in type 1 diabetes. SGLT2is provide cardio-renal benefits, despite an increase in the risk of DKA and urinary tract infection compared with GLP-1 RA therapy. Long-term evaluation of the efficacy and safety of these adjunctive therapies is required to guide their use in individuals with type 1 diabetes.\n \n \n Graphical Abstract},\n\tlanguage = {en},\n\tnumber = {10},\n\turldate = {2024-06-04},\n\tjournal = {Diabetologia},\n\tauthor = {Anson, Matthew and Zhao, Sizheng S. and Austin, Philip and Ibarburu, Gema H. and Malik, Rayaz A. and Alam, Uazman},\n\tmonth = oct,\n\tyear = {2023},\n\tpages = {1869--1881},\n}\n\n","author_short":["Anson, M.","Zhao, S. S.","Austin, P.","Ibarburu, G. H.","Malik, R. A.","Alam, U."],"key":"anson_sglt2i_2023","id":"anson_sglt2i_2023","bibbaseid":"anson-zhao-austin-ibarburu-malik-alam-sglt2iandglp1ratherapyintype1diabetesandrenovascularoutcomesarealworldstudy-2023","role":"author","urls":{"Paper":"https://link.springer.com/10.1007/s00125-023-05975-8"},"metadata":{"authorlinks":{}}},"bibtype":"article","biburl":"https://api.zotero.org/users/10910479/collections/VBK658MW/items?key=5uUWcBcPFQk1LqJLzvo33ske&format=bibtex&limit=100","dataSources":["pwY2dhrET2rBBcDhK"],"keywords":[],"search_terms":["sglt2i","glp","therapy","type","diabetes","reno","vascular","outcomes","real","world","study","anson","zhao","austin","ibarburu","malik","alam"],"title":"SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes: a real-world study","year":2023}