Initial results of the first randomized controlled trial of sodium-glucose cotransporter-2 (SGLT2) inhibitors in adolescents with type 1 diabetes will be released in Orlando at the 84th Scientific Sessions. SGLT2 inhibitors are widely used in type 2 diabetes, but studies are limited in adolescents with type 1 diabetes.
“This is going to be a landmark study evaluating the early changes of kidney function in type 1 diabetes and evaluating medications that have been game changers in the type 2 population for the prevention of complications, particularly in the kidney and the heart,” said Farid Mahmud, MD, Staff Physician in the Division of Endocrinology at The Hospital for Sick Children, Toronto, Canada, and Associate Professor of Pediatric Endocrinology at the University of Toronto. “The study was fully recruited to look at two questions: how do we prevent kidney complications and how do we optimize diabetes control in teenagers and young adults at a period when their diabetes is so often off track?”
Dr. Mahmud will present the renal and glycemic outcomes during Use of SGLT2i in Youth with Type 1 Diabetes: Results from ATTEMPT (The Adolescent Type 1 Diabetes Treatment with SGLT2i for hyperglycEMia & hyPerfilTration Trial), which will take place on Monday, June 24, from 3:15 p.m. – 4:15 p.m. ET in Room W414 of the Orange County Convention Center.
The multicenter, double-blinded, placebo-controlled Canadian and U.S. trial was designed to assess the impact of SGLT2 inhibitor versus placebo in combination with insulin therapy. The primary outcome is change in measured glomerular filtration rate over 16 weeks. Secondary outcomes include a variety of diabetes outcomes including A1C, glycemic variability, cardiovascular measures, renal imaging, safety measures, and treatment satisfaction.
Petter Bjornstad, MD, Director of the University of Washington Medicine Diabetes Institute, will discuss the rationale for SGLT2 inhibitor adjunctive therapy in adolescents who have type 1 diabetes.
Studies in adults have shown that SGLT2 inhibitors can help lower A1C and can slow the progression of kidney damage, Dr. Mahmud explained. Renal-protective effects make these agents attractive to use earlier in type 1 diabetes with the hope of reducing earlier stage kidney damage and slowing progression toward chronic kidney disease.
“The kidney is an insidious complication of diabetes, but it has significant morbidity and mortality,” he said. “Finding tools that can prevent, or at least delay, this complication at an earlier stage is critical for us to improve the quality of life and clinical outcomes for everyone with type 1 diabetes.”
Samantha Anthony, PhD, MSW, RSW, Health Clinician-Scientist in the Transplant and Regenerative Medicine Centre at The Hospital for Sick Children Research Institute and Associate Professor of Social Work at the University of Toronto, will discuss patient perspectives on diabetes management revealed by the ATTEMPT trial.
“We kept a keen eye on the experience of participants in the study,” Dr. Mahmud said. “Teenagers have the highest A1Cs across the lifespan, and puberty is a challenging period during which diabetes complications can start and progress. This is a particularly important window for us to look at interventions that can prevent early subclinical kidney complications and optimize diabetes control. ATTEMPT will give us practical information on the effectiveness and safety of SGLT2 inhibitors in an at-risk population that we believe could benefit from them.”