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Abstract: SA-OR23

Sodium-Glucose Cotransporter 2 Inhibitors as Adjunct Therapy for Type 1 Diabetes and the Benefit on Cardiovascular and Renal Disease Evaluated by Steno Risk Engines

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Stougaard, Elisabeth B., Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Vistisen, Dorte, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Persson, Frederik, Steno Diabetes Center Copenhagen, Gentofte, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Background

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have beneficial cardiovascular and renal effects in persons with type 2 diabetes but no studies have shown whether this can be demonstrated in type 1 diabetes (T1D). We aimed to estimate the risk of cardiovascular disease (CVD) and end-stage kidney disease (ESKD) in persons with T1D with and without treatment with SGLT2i.

Methods

The study is based on 3,660 adults with T1D treated from 2001-2016 who fulfilled the inclusion criteria of age 30-75 years and an eGFR >45 ml/min/1.73 m2. The Steno Type 1 Risk Engine was used to calculate 5-year cumulative risks of ESKD and in the subset of 3,284 (89.7%) without previous CVD at baseline, 5- and 10-year cumulative risk of CVD were estimated. The effect of SGLT2i was simulated by changing the recorded HbA1c and systolic blood pressure (SBP) values in accordance with results from the DEPICT studies. Individual absolute change in HbA1c and SBP was simulated as randomly drawn numbers from a normal distribution with mean (standard deviation (SD)) of -3.6 (0.9) mmol/mmol and -1.12 (2.8) mmHg. The recorded eGFR and albuminuria were changed in accordance with results from the Tandem studies; no change in eGFR and mean (SD) %-change in albuminuria of -23.7 (12.9).

Results

The SGLT2i induced change in the risk variables translated into an overall 5-year CVD relative risk reduction of 6.1% (95%CI 5.9,6.3), with up to 11.1% (10.0,12.2) in the subgroup with albuminuria. Similar results were seen for the 10-year risk of CVD. For the estimated 5-year risk of ESKD, we found an overall relative risk reduction of 5.3% (5.1,5.4) with up to 7.6% (6.9,8.4) in the subgroup with albuminuria.

Conclusion

Using the Steno T1 CVD and renal risk engine we estimated the risk of CVD and ESKD in persons with T1D with and without treatment with SGLT2i and found a substantial CVD and ESKD risk reduction, especially in the subgroup with albuminuria. Our model provides an estimate of benefit that may balance the risks associated with use of SGLT2 inhibition in T1D.