Off-label glucose-lowering drugs Poses Risks for Type 1 Diabetes Patients
A collaborative study led by Emory University's Rollins School of Public Health highlights the risks associated with prescribing off-label glucose-lowering medications to individuals with type 1 diabetes (T1D). Researchers express concern over the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors, which have demonstrated cardiovascular and renal benefits in type 2 diabetes but pose unique dangers for T1D patients.
SGLT2 inhibitors, in particular, are linked to a significant risk of euglycemic diabetic ketoacidosis, a potentially life-threatening condition characterized by dangerously high acid levels in the blood, common in T1D individuals. Consequently, these medications have been removed from use in T1D patients in Europe, and the U.S. Food and Drug Administration (FDA) has not approved them for this population.
GLP-1RAs are known for promoting weight loss, which can complicate insulin needs and lead to risks such as ketoacidosis and hypoglycemia in T1D patients. The research letter published in JAMA emphasizes the urgent need for further studies to assess the safety and efficacy of these medications for T1D.
Analyzing data from the Epic Cosmos database, the study identified 943,456 T1D patients from 2010 to 2023. It found that those prescribed SGLT2 inhibitors had higher rates of pre-existing cardiovascular issues and chronic kidney disease, indicating these drugs are being used off-label to manage complications associated with T1D.
Meanwhile, the usage of GLP-1RAs increased significantly among T1D patients, particularly for managing obesity, which is a vital aspect of diabetes care. The study noted that the percentage of T1D patients prescribed GLP-1RAs rose from 0.3% in 2010 to 6.6% by 2023.
Despite the growing trend in off-label prescriptions, concerns remain regarding the safety of these treatments in T1D. The researchers call for prospective studies to evaluate the efficacy and safety of GLP-1RAs and SGLT2 inhibitors for T1D patients before widespread adoption of these medications. Until more evidence is available, caution is advised in their prescription for individuals with type 1 diabetes.
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