888-P: Urinary Albumin Levels Prior to SGLT2 Inhibitors Initiation Predict Increased TIR after 12 Months in Patients with Type 1 Diabetes on Sensor-Augmented Pump Therapy

Abstract

Purpose: SGLT2 inhibitors (SGLT2i) have been shown to improve glycemic control in patients with type 1 diabetes (T1D). Predictors of SGLT2i efficacy in patients with T1D on sensor-augmented pump (SAP) therapy were investigated. Methods: Patients with T1D on SAP therapy attending our hospital who were newly initiated on SGLT2i between 2019-2020 and followed for at least one year, were included in the study. Data on BMI, blood tests, and continuous glucose monitors were compared before and 12 months after SGLT2i initiation. The predictors of time in range (TIR) change (ΔTIR) were determined by multiple regression analysis. The cutoff values for predictors of ΔTIR above the median at the end of the study were determined using ROC curve analysis. Results: 17 patients (70.6% females, median age 44.0 years) were included in the analysis, except for three patients who discontinued SGLT2i due to side effects. Median BMI and eGFR decreased significantly from 25.3 kg/m2, and 79.0 ml/min/1.73m2 at baseline to 23.9 kg/m2, and 73.0 ml/min/1.73m2 (p = 0.013, p = 0.002, respectively), while total daily dose of insulin, basal-to-total insulin ratio, and urinary albumin-to-creatinine ratio (UACR) showed no significant change (40.1 vs 41.0 units [p = 0.084], 40.1 vs 38.5% [p = 0.266], 7.0 vs 2.0 mg/g [p = 0.285], respectively). HbA1c, TIR, and TAR improved significantly (8.2 vs 7.8% [p = 0.004], 53.0 vs 61.0% [p = 0.003], and 47.0 vs 36.0% [p = 0.003], respectively), while TBR showed no significant change (0.4 vs 0.8% [p = 0.309]). Predictors of increased ΔTIR were overweight and high UACR at baseline (p = 0.026) and the cutoff value for UACR that predicted ΔTIR above the median was 28.0 mg/g (AUC = 0.82 [95%CI, 0.61-1.03]; p = 0.003). Conclusion: SGLT2i improved glycemic control of patients with T1D on SAP therapy without increasing TBR. It was also suggested that patients with UACR above 28.0 mg/g could have greater impact on TIR improvement after 12 months. Disclosure Y.Suganuma: None. H.Takahashi: Speaker's Bureau; Eli Lilly Japan K.K., Boehringer Ingelheim Japan, Inc., Medtronic, Novo Nordisk. T.Ohno: None. R.Nishimura: Speaker's Bureau; Sanofi K.K., Medicure Inc., Boehringer Ingelheim Inc., Takeda Pharmaceutical Company Limited, Kissei Pharmaceutical Co., Ltd., Novartis Pharma K.K., Eli Lilly Japan K.K., Novo Nordisk, Merck & Co., Inc., Abbott Japan Co., Ltd., Astellas Pharma Inc., Teijin Pharma Limited, Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., AstraZeneca.