The need for carbohydrate counting could be eliminated for users of closed‐loop automated insulin delivery systems by using an SGLT2 inhibitor to reduce postprandial glycaemic exposure, Canadian research suggests

People with type 1 diabetes using a hybrid close loop system were able to use a hybrid closed loop system without car counting if they also took empagliflozin (25 mg/daily) as an adjunct to insulin, a pilot study involving 30 patients found.

However the use of the SGLT2 inhibitor did not eliminate the need for meal announcement  – pushing a button to deliver a prandial partial insulin bolus  – among users of the automated delivery systems, according to findings published in Diabetes Obesity and Metabolism.

The study conducted by clinicians at McGill University involved 30 adults with T1D who were using closed loop systems based on pumps such as the Medtronic 630G and Dexcom G5 sensor

The patients had glucose levels  assessed while using three different prandial insulin strategies with and without empagliflozin: either carbohydrate counting, simple meal announcement (no carbohydrate counting) and no meal announcement.

Use of empagliflozin without a meal announcement was found to be inferior to the control comparator of carbohydrate counting and no empgaliflozin (mean glucose 10.0 ± 1.6 vs. 8.5 ± 1.5 mmol/L).

However, when empagliflozin was used with a simple meal announcement the mean glucose level was non-inferior to the carbohydrate counting control without empagliflozin strategy: 8.5 ± 1.4 mmol/L vs 8.5 ± 1.5 mmol/L; non‐inferiority p = .007).

And compared to the control arm, the simple meal announcement strategy with empagliflozin also had similar times in the target range, hyperglycaemia more than 10.0 mmol/L, and hypoglycaemia less than 3.9 mmol/L.

The study also showed that if empagliflozin was used in addition to carbohydrate counting with automated insulin delivery, it was associated with lower mean glucose, corresponding to a 14% greater time in the target range.

No ketoacidosis was observed, but mean fasting ketones levels were higher on empagliflozin (0.22 ± 0.18 vs. 0.13 ± 0.11 mmol/L; p < .001).

The study investigators said their preliminary results suggested that the use of an SGLT2i offered the potential to eliminate carbohydrate counting in pump users. This would be a major benefit given that carbohydrate counting was  challenging  and often led to people, preferring pre-packaged foods over fresh and whole food for the ease of labelling of carbohydrate content

“Longer term studies are now warranted to determine the effect on long‐term glycaemic control and to further investigate the putative risk of ketosis and diabetic ketoacidosis associated with automated insulin delivery and adjunct‐to‐insulin SGLTis,” they concluded..