The type 2 diabetes drug Jardiance (empagliflozin) was found to help people with type 1 on automated insulin delivery — those using a closed-loop system, with a glucose sensor and insulin pump — reduce carbohydrate counting without it worsening their blood glucose control, according to a new study published in the journal Diabetes, Obesity and Metabolism.
Researchers in Canada looked at a study group of 30 people with type 1 who had previously been using an insulin pump for longer than three months. Their average age was 40, with an average diabetes duration of 27 years, and their average A1C level (a measure of long-term blood glucose control) was 7.6%.
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Each participant received automated insulin delivery as part of the study, which lasted for two months, as noted in an article at Endocrinology Advisor. During this time, they followed three different regimens or strategies for delivering mealtime insulin — carb counting, meal announcements, or no counting or announcements. Counting carbs or announcing a meal ahead of time, by entering this information into the closed-loop system, helps the computer algorithm deliver insulin optimally, since it knows to expect a meal containing carbohydrate.
During each sequence of following the three strategies for mealtime insulin — which happened in a random order during the study period — participants were randomly assigned either to take or not to take 25 milligrams of Jardiance daily.
Compared with standard carb counting and not taking Jardiance, taking Jardiance without carb counting or a meal announcement resulted in slightly worse blood glucose control after meals. But taking Jardiance with a simple meal announcement was found to result in identical blood glucose control — a post-meal average of 153 mg/dl — as carb counting without Jardiance. It’s possible, then, that taking Jardiance could let people with type 1 ease or entirely eliminate carb counting on a closed-loop insulin delivery system without experiencing worse blood glucose control.
What’s more, when participants took Jardiance on top of counting carbs, they experienced a 14% increase in staying within their target blood glucose range. This benefit occurred without any significant side effects, although fasting ketone levels were higher when participants took Jardiance — but without any cases of diabetic ketoacidosis. There were 18 incidents of hypoglycemia (low blood glucose) when participants counted carbs without taking Jardiance, 18 incidents when they counted carbs while taking Jardiance, and 10 incidents when they did a simple meal announcement while taking Jardiance.
The researchers concluded that combined with automated insulin delivery, taking Jardiance for type 1 diabetes “has the potential to eliminate the need for carbohydrate counting and improves glycemic control in conjunction with carbohydrate counting.” But it doesn’t allow users to skip meal announcement as part of their closed-loop system without experiencing worse blood glucose control. More studies, and larger ones, are needed before there can be official recommendations about taking Jardiance for type 1 and how this could allow for different mealtime insulin strategies.
Want to learn more about carbohydrate counting? Read “Counting Carbohydrates Like a Pro.”