2017 Volume 60 Issue 1 Pages 10-17
When combining sodium-glucose co-transporter 2 (SGLT2) inhibitors with insulin therapy, it is recommended that the insulin dose be reduced while paying careful attention to the occurrence of hypoglycemia. We previously conducted a retrospective investigation in patients treated with this combination, and our findings revealed that a mean decrease of 15 % in the total insulin dose is effective and safe, and that reducing long-acting insulin results in a greater decrease of hemoglobin (Hb) A1c. In order to verify these results, we conducted a prospective study where 27 patients with ≥7 %HbA1c were randomly assigned to two groups: including one receiving a 15 % reduction in rapid-acting insulin alone with subsequent additions (the rapid reduction group); and another receiving a 15 % reduction in long-acting insulin alone (the long reduction group). HbA1c was thus observed to significantly decrease in both groups after 2 months (-0.3 % in rapid reduction group; -0.5 % in long reduction group). However, these decreases did not differ significantly between the groups and the impacts of such dose reduction on the treatment effects were similar between the groups. In addition, no serious side effects were observed. Our results demonstrated that a 15 % reduction in the total insulin dose, when combined with SGLT2 inhibitors, is therefore considered to be safe and effective, while indicating that specific adjustments depending on the type of insulin are not necessary.
