Schafer Boeder, MD: Role of SGLT2 Inhibitors and GLP-1s in Type 1 Diabetes

In this expert conversation at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Schafer Boeder, MD, an endocrinologist and assistant professor of medicine at the University of California, San Diego, delved into the use of adjunctive therapies, including sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucogon-like peptide-1 (GLP-1) receptor agonists in type 1 diabetes (T1D), with a focus on addressing overweight and obesity, insulin resistance, and cardiovascular risk.

While T1D has traditionally been associated with lean individuals, Boeder highlighted the growing prevalence of obesity in this population and the need for treatments beyond insulin monotherapy to tackle these metabolic challenges. Despite promising data extrapolated from type 2 diabetes (T2D) studies, he indicated these therapies lack robust, type 1-specific outcome data, particularly regarding kidney and cardiovascular protection.

The discussion also underscored the barriers to broader adoption of SGLT2 inhibitors, particularly the risk of diabetic ketoacidosis (DKA). Boeder emphasized strategies to mitigate DKA risk, including careful patient selection, education on risk management, and the use of protocols such as STOP and STITCH. He also pointed to the potential of emerging technologies like continuous ketone monitoring to further enhance safety.

Looking ahead, Boeder advocated for more research focused on T1D, such as the ongoing Sugar and Salt trial exploring renal outcomes with SGLT1/2 inhibitors. He also highlighted the transformative potential of advances in obesity medicine, including newer GLP-1 receptor agonists and triple agonists, which offer substantial weight loss and broad metabolic benefits. These developments could signal a shift toward more holistic and preventive care approaches, even as challenges such as cost, side effects, and regulatory approval remain.

Disclosures: Relevant disclosures for Boeder include Cecelia Health, Dexcom, Eli Lilly, REMD, and Biotherapeutics Inc.

Reference

_{Boeder S. The Role and Safety of SGLT2i and GLP1 RA Therapy in T1D. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.}