Objective: To determine the effect of SGLT<sub>2</sub>
inhibitor dapagliflozin on glucose flux, lipolysis and ketone body
concentrations during insulin withdrawal in people with type 1 diabetes.
<p> </p>
<p>Research Design
and Methods: A double-blind placebo controlled
crossover study with a 4-week wash out period was performed in 12 people with
type 1 diabetes using insulin pump therapy.
Participants received dapagliflozin or placebo in random order for 7
days. Stable isotopes were infused to measure the rate of glucose production (Ra),
disappearance (Rd) and lipolysis. At isotopic steady state insulin was
withdrawn and the study terminated after 600 minutes or earlier if blood
glucose reached 18mmol/L, bicarbonate <15mmol/L, venous pH <7.35 or
capillary ketones >5.0 mmol/L. </p>
<p><br></p><p>Results: At
baseline, glucose Ra was significantly higher
with dapagliflozin than placebo. Following insulin withdrawal, plasma glucose
concentrations at the end point were significantly
lower with dapagliflozin than placebo and AUC<sub>0-180min </sub>glucose Rd and
AUC<sub>0-180min </sub>β-hydroxybutyrate (BOHB)
were significantly higher. There was a small but significantly higher AUC<sub>0-180min
</sub>glycerol Ra (measure of lipolysis) with dapagliflozin. Non-esterified fatty acid
concentrations were not different between treatments.</p>
<p>When
divided by BMI>27 and <27kg/m<sup>2</sup>, basal glucose Ra and BOHB, and
AUC<sub>0-180min </sub>glycerol Ra were significantly higher in the low BMI
group with dapaglifozin versus placebo treatment.</p>
<p><br></p><p>Conclusions: During
insulin withdrawal
the increase in BOHB with dapaglifozin may
be partially due to increased lipolysis.
However reduced renal excretion, reduced BOHB uptake by peripheral tissues or a
metabolic switch to increase ketogenesis within the liver may also
play a role. <u></u></p>
Metabolic Effects of an SGLT2 Inhibitor (Dapagliflozin) During a Period of Acute Insulin Withdrawal and Development of Ketoacidosis in People With Type 1 Diabetes
