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Summary of April Journal Club: Impact of empagliflozin (and SGLT2i) on the amount of insulin required by people with T1D on pump and CGM

By Lucia Novak posted 16 days ago


Please find the PPT summary of the April AP CPI Journal Club April 27, 2021


Journal Article:
Reducing the need for carbohydrate counting in type1 diabetes using closed-loop automated insulin delivery (artificial pancreas) and empagliflozin: A randomized, controlled, non-inferiority, crossover pilot trial

Authors: Ahmad Haidar PhD | Jean-Francois Yale MD| Leif Erik Lovblom MSc |

Nancy Cardinez NP | Andrej Orszag MD| C. Marcelo Falappa MD |

Nikita Gouchie-Provencher RN | Michael A. Tsoukas MD | Anas El Fathi PhD |

Jennifer Rene RN | Devrim Eldelekli BM | Sebastien O. Lanctôt |

Daniel Scarr BSc | Bruce A. Perkins MD


Aim: To assess whether adding empagliflozin to closed-loop automated insulin delivery

could reduce the need for carbohydrate counting in type 1 diabetes (T1D) without

worsening glucose control.

Materials and Methods: In an open-label, crossover, non-inferiority trial, 30 adult

participants with T1D underwent outpatient automated insulin delivery interventions

with three random sequences of prandial insulin strategy days: carbohydrate counting,

simple meal announcement (no carbohydrate counting) and no meal announcement.

During each sequence of prandial insulin strategies, participants were randomly

assigned empagliflozin (25 mg/day) or not, and crossed over to the comparator. Mean

glucose for carbohydrate counting without empagliflozin (control) was compared with

no meal announcement with empagliflozin (in the primary non-inferiority comparison)

and simple meal announcement with empagliflozin (in the conditional primary noninferiority


Results: Participants were aged 40 ± 15 years, had 27 ± 15 years diabetes duration

and HbA1c of 7.6% ± 0.7% (59 ± 8 mmol/mol). The system with no meal announcement

and empagliflozin was not non-inferior (and thus reasonably considered inferior)

to the control arm (mean glucose 10.0 ± 1.6 vs. 8.5 ± 1.5 mmol/L; non-inferiority

p = .94), while simple meal announcement and empagliflozin was non-inferior

(8.5 ± 1.4 mmol/L; non-inferiority p = .003). Use of empagliflozin on the background

of automated insulin delivery with carbohydrate counting was associated with lower

mean glucose, corresponding to a 14% greater time in the target range. While no

ketoacidosis was observed, mean fasting ketones levels were higher on empagliflozin

(0.22 ± 0.18 vs. 0.13 ± 0.11 mmol/L; p < .001).

Conclusions: Empagliflozin added to automated insulin delivery has the potential to

eliminate the need for carbohydrate counting and improves glycaemic control in conjunction

with carbohydrate counting, but does not allow for the elimination of meal