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SGLT inhibitors for type 1 diabetes: a finely balanced matter?

David Morris explains the latest guidance on the use of sodium-glucose co-transporter 2 inhibitors

The utilisation of sodium-glucose co-transporter 2 (SGLT-2) inhibitors for type 2 diabetes (T2DM) in primary care has increased dramatically since dapagliflozin first became available in the UK in November 2012. The mechanism of action of SGLT-2 inhibitors suggested that they might also be effective glucose-lowering agents in type 1 diabetes (T1DM) and emerging evidence in the last few years supports this concept.

This article reviews the evidence supporting use of SGLT inhibitors in T1DM and the risks associated with their use, most notably that of diabetic ketoacidosis (DKA). The practicalities of selecting and managing individuals suitable for treatment with SGLT inhibitors are addressed in light of recent NICE guidance on dapagliflozin and sotagliflozin.1,2

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