- Off-label SGLT2 inhibitors increase the risk of euglycemic diabetic ketoacidosis.
- GLP-1RAs may lead to rapid weight loss in type 1 diabetes, complicating insulin management.
- Use of these drugs in type 1 diabetes has grown driven by the need to address obesity, heart, and kidney health.
recent study by Emory University Rollins School of Public Health highlights concerns around prescribing off-label glucose-lowering drugs, specifically GLP-1 receptor agonists (GLP-1RAs) and SGLT2 inhibitors, to people with type 1 diabetes.
While these drugs are known for cardiovascular and renal benefits in type 2 diabetes, and GLP-1RAs also support weight loss, their use in type 1 diabetes carries significant risks.
SGLT2 inhibitors, for example, have been linked to euglycemic diabetic ketoacidosis (EDKA), a life-threatening condition where blood acidity reaches dangerous levels without high glucose.
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Due to this, SGLT2 inhibitors were withdrawn from type 1 diabetes treatment in Europe, and the FDA has not approved them for this group.
Similarly, while GLP-1RAs can aid in weight management, substantial weight loss in people with type 1 diabetes may lead to changes in insulin needs, increasing the risk of ketoacidosis and hypoglycemia.
Published in JAMA, the study reviewed data from 943,456 individuals with type 1 diabetes (2010-2023) through the Epic Cosmos database, finding that while these drugs were used off-label, clinicians were often motivated by the need to manage obesity and cardiovascular or renal complications in type 1 diabetes.
Specifically, patients prescribed SGLT2 inhibitors had higher rates of heart failure and kidney disease, while those on GLP-1RAs had higher obesity rates, indicating that these drugs were used to address cardiorenal and weight issues.
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Notably, from 2010 to 2023, the use of GLP-1RAs and SGLT2 inhibitors in type 1 diabetes patients grew significantly, with a particular rise in prescriptions for semaglutide (Ozempic, Rybelsus, and Wegovy) among type 1 diabetes patients.
Despite the regulatory concerns and safety risks, this off-label use reflects the drugs’ perceived benefits in areas like heart and kidney health and weight management.
The researchers concluded that until more safety and efficacy data are available, extreme caution is advised for using these treatments in type 1 diabetes.
Future studies are needed to validate the potential benefits while mitigating risks in this population.
