In a Diabetes Care perspective, endocrinologists, nephrologists and cardiologists reviewed what is known about SGLT inhibitors in type 1 diabetes and what it would take to bring them to heart and kidney protection in that population.
Their argument: the mechanisms behind cardiorenal benefit in type 2 diabetes and in people without diabetes are likely to apply in type 1. Given that, registration trials might use surrogate end points rather than being powered for hard cardiovascular or kidney events, which would make trials feasible. Diabetic ketoacidosis (DKA) remains the critical risk; mitigation protocols exist, but rigorous evidence that they work is lacking.
This is expert opinion, not new trial data. It does not change what is licensed. It does frame the question clinicians are already being asked by patients with type 1 diabetes and chronic kidney disease or heart failure.
- SGLT inhibitors are not approved for heart or kidney protection in type 1 diabetes; any use is off-label and specialist-led.
- DKA, including euglycaemic DKA, is the dominant risk in type 1 diabetes and can occur with near-normal glucose.
- If an SGLT inhibitor is used, ketone monitoring and written sick-day rules are essential, not optional.
- Expect future trials to report kidney and heart surrogates such as albuminuria and eGFR slope rather than events.
Why it matters
The cardiorenal benefit that type 2 patients receive may be within reach for type 1, but only if DKA risk can be shown to be controllable.
Don't overread it
This is a perspective piece; it adds no new efficacy or safety data.
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