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NICE recommends dapagliflozin as type 1 diabetes treatment

Discussion in 'Diabetes News' started by DCUK NewsBot, Jul 15, 2019.

  1. DCUK NewsBot

    DCUK NewsBot · Well-Known Member

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    A drug used to treat type 2 diabetes has been recommended by health watchdog NICE to treat people with type 1 diabetes. Dapagliflozin (marketed as Forxiga) is an SGLT2 inhibitor which helps the kidneys remove glucose from the blood and pass it out through urine. It was first approved by the EU for treating type 2 diabetes in November 2012 and has since become the first licenced oral add-on therapy to insulin in type 1 diabetes. Although, it does present an increased risk of diabetic ketoacidosis (DKA) in type 1 diabetes. NICE says that dapagliflozin is not a replacement for insulin in type 1 diabetes but could be used alongside as insulin if certain criteria are met. It is estimated that around 90,000 people could be eligible. Last week, NICE leant its support to the drug, calling it an "innovative treatment" for adults with type 1 diabetes who have a body mass index (BMI) of 27 kg/m2 or more and are struggling to control their blood glucose levels. NICE has prepared draft guidance with criteria for when dapagliflozin would be appropriate for adults with type 1 diabetes, and if no appeals are lodged it will release the final guidance in August. Previously, a NICE appraisal committee had previously not recommended dapagliflozin, with more information requested. Explaining this latest decision, NICE said: "At present, dapagliflozin with insulin is considered to have only modest benefits based on the evidence from clinical trials. These showed small improvements in blood glucose levels and weight loss, and very small improvements in quality of life. NICE's independent appraisal committee however highlighted an unmet need for interventions that help people to reach good glycemic control without complications."

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  2. ickihun

    ickihun Type 2 · Master

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    Long term thrush may eventually cause complications..... surely?

    I hv on my notes... No more Dapagliflozin or canagliflozin due to severe side effects. Never again.

    If it works for you than be aware of possible ketones even on excellent bgs.
    Ive come to the conclusion that circulating blood benefits from the med due to swollowing tablet. The kidney is activated to flush existing(old) circulated blood (deoxygenised). After the lungs adding oxygen but after it circulated into the kidneys so due to be returned to the lungs pumped by the heart to be oxygenised and sent to finger tips.
    Hence the benefit of lower bgs in blood cells (oxygenised ones) but thrush due to urine laced with glucose from the kidneys filter.
    A low protein and low carb diet helped with Dapagliflozin.
    However I'm a type2 not type1.

    I'd never use these meds again because I'm susceptible to thrush anyway but this med made it unbareable and made me very unhappy but to lose weight for my op it gave me a 8lb loss.
     
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  3. tim2000s

    tim2000s Type 1 · Expert
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    People with type 1 on low carb diets potentially run a higher risk of DKA with Dapagliflozin than those with Type 2. especially if starting from a ketogenic state, as you're managing ketones with exogenous insulin alone.

    If I'm honest, I doubt that anyone in the trials followed a ketogenic diet, and the NICE guidance says not to give it to people who are.
     
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  4. Muneeb

    Muneeb Type 1 · Well-Known Member

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    I'd rather my kidneys are not worked any more than they need to be, I will carry on using insulin to shuffle glucose into muscles rather than extra processing via the kidneys.
     
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  5. Mel dCP

    Mel dCP Type 1 · Well-Known Member

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    Not sure I fancy thrush, UTIs or the increased risk of euglycaemic DKA just to be thinner...
     
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  6. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    The fact that it is aimed at those with bmi 27+ and wobbly control implies double diabetes e.g. insulin resistance as well as lack of own insulin.
    I think it would be wrong for diabetologists to suggest this drug without mentioning that the best way to improve insulin resistance is to eat less carbs and therefore require less insulin. I know that not everyone is capable of making those changes and that some people are so insulin resistant that they may need some pharma or surgical help so it is good that there's a tool to help.
    This class of drugs, unlike other types of type 2 drugs, is reckoned to prevent heart problems caused by long term higher blood sugars since the glucose is excreted from the body but I would not take this until I had tried plan A (keto)! Have been offered metformin as a type 1 but feel a little more confident with keto and my fsl that I can get levels into a pre diabetic range.
     
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  7. ickihun

    ickihun Type 2 · Master

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    This med has been tested on kidney function performance and found no detriment. However the research may hv been on type2s.
     
  8. ickihun

    ickihun Type 2 · Master

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    Metformin is a fantastic med. I really miss it. One day I'd like to think I will be able to tolerate it, with IBS. Only started with IBS on low carb eating. Still hv bouts of it but far less frequent since Roux-en-y.
    Roux-en-y can resolve IBS in 50% of patients. (American statistic)
    Endo may test me for type1, maybe. If I still need novarapid on mouseful of food it may indicate no natural insulin response. Only no carb food can struggle without insulin, currently. But I want another 4st weight loss. We'll see.
    I had diabetic symptoms at 6yr old then went 600-800cal at 14yr old. I hv autoimmune conditions which weren't treated til I was 22yr old. 32 was diagnosed with type2. Mainly because of my weight.
     
  9. Muneeb

    Muneeb Type 1 · Well-Known Member

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    Kidney failure happens over a lifetime, and can take decades. I doubt they have done decades of controlled testing with this. The fact your kidney's will be working harder, every day, for the rest of your life, means more stress and naturally higher rate of failure.
     
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  10. ringi

    ringi Type 2 · Well-Known Member

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    The way I think of it.
    • dapagliflozin (and other SGLT-2i) => put the excess glocose from the blood system down the wc
    • Low carb => put a lot less glocose into the blood system
    Both can result in BG levels that "are not too bad" when inslin levels are very low, combine the two and there is little warning about inslin failing to work if only BG is monitored.

    (SGLT-2i are also very high risk if combined with breastfeeding, as breastfeeding removes glocose independently of inslin levels.)
     
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  11. ringi

    ringi Type 2 · Well-Known Member

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    As drinking more water reduces risks to the kidneys, the concept of "kidneys working harder" due to SGLT-2i does not make sence.

    They have done the study in type2, and the reduction in BG and BP greater slows down the kidney failure in people who are near end stage kidney failure. Remember that high inslin levels also effects the kidneys and SGLT-2i results in lower inslin levels.

    The guildlines are written so SGLT-2i are only used people with type1 when they are lickly to have very high inslin resistance. (Personally I think very low carb is a better option for nearly everyone with high inslin resistance.)
     
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  12. ickihun

    ickihun Type 2 · Master

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    I agree.
    Not enough info but good for fast and temporary results. With horrific side effects. I'm just getting over the thrush months later from stopping it. My poor kidneys have taken the brunt of my operation for sure. Water is the best detox.
     
  13. etmsreec

    etmsreec Type 1 · Well-Known Member

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    I don't understand why this is being prescribed or promoted, given the increased rate of UTIs and thrush that it must cause?
    As someone whose control was rubbish (and my consultant would probably say still is!), I ended up having a circumcision due to the scarring and tightness that repeated Thrush infections caused.
     
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  14. ringi

    ringi Type 2 · Well-Known Member

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    Think of it as being "low-carb in a pill" and hence easyer then the NHS helping people to limit high GI carb intake to the level that is compactable with them getting good BG control.
     
  15. ickihun

    ickihun Type 2 · Master

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    Dapagliflozin removes glucose but it can come from protein equally. My protein can give higher bgs. Well before my bariatric op.
     
  16. kerrygold59

    kerrygold59 Prediabetes · Member

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    ££££££ course they want you to take their drugs, CUT carbs and look up Dr Bernstein.
     
    #16 kerrygold59, Aug 1, 2019 at 12:22 PM
    Last edited by a moderator: Aug 1, 2019
  17. Rokaab

    Rokaab Type 1 · Well-Known Member

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    You do realise that this thread is about Type 1's, and Type's have no choice but to take insulin as without it we would not survive, even on a low carb diet.
     
    #17 Rokaab, Aug 1, 2019 at 12:30 PM
    Last edited by a moderator: Aug 1, 2019
  18. Muneeb

    Muneeb Type 1 · Well-Known Member

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    TBF, Dr Bernstein advocates low carb (<30g per day) and that's only from veg to get nutrients, and is aimed at type 1's. Dr Bernstein also has concerns over recommending these for type 1's as long term effect on overworking the kidney's is not clear.

    Obviously insulin is still used though.
     
    • Agree Agree x 1
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