A Roadmap for SGLT Inhibitors in Type 1 Diabetes: Protecting Hearts and Kidneys

Heart disease and chronic kidney disease are serious, lifelong threats for many people with type 1 diabetes. Kidney disease can progress to kidney failure, requiring transplant or dialysis. When kidney disease develops, it also increases the risk of heart problems, including heart failure and atherosclerosis. Currently, treatment options to prevent or slow these complications are limited.

SGLT inhibitors are a class of drugs already approved for type 2 diabetes and have shown clear benefits in protecting the heart and kidneys. The question researchers are now asking: Can these same drugs work safely in type 1 diabetes?

Experts from endocrinology, nephrology, and cardiology reviewed what we know about SGLT inhibitors. Their conclusion: the biological mechanisms that make these drugs effective for heart and kidney protection in type 2 diabetes are likely to work the same way in type 1 diabetes. This is an important finding because it suggests the drugs' proven benefits could translate to people with type 1 diabetes.

However, type 1 diabetes presents a unique safety challenge. SGLT inhibitors carry an increased risk of diabetic ketoacidosis (DKA)—a serious, potentially life-threatening condition where the blood becomes too acidic. This risk, which is much lower in type 2 diabetes, has been a major obstacle to developing and using SGLT inhibitors in type 1 diabetes.

In September 2026, experts published a detailed roadmap in the journal Diabetes Care, titled 'SGLT Inhibitors for Heart and Kidney Disease in Type 1 Diabetes.' The publication, led by Jonathan Rosen, Ph.D., and colleagues at Breakthrough T1D, outlines practical steps to move SGLT inhibitors forward safely.

The roadmap addresses three key areas: how to design clinical trials that can realistically test these drugs, how to use surrogate endpoints (measurable markers of heart and kidney health) instead of waiting years for traditional outcome data, and critically, how to develop and implement rigorous DKA prevention protocols.

One important recommendation is that future trials may not need to be as large or lengthy as traditionally required. By using reliable surrogate endpoints to measure heart and kidney benefit, researchers can conduct more feasible studies while still gathering meaningful safety data.

While the scientific evidence is encouraging, real-world perspectives from people with type 1 diabetes and their physicians reveal important nuances. Qualitative research with 24 people living with long-standing type 1 diabetes and 7 physicians found that both groups weigh risks and benefits carefully—some expressing hesitancy to move beyond established treatments, others recognizing the urgent need for better heart and kidney protection.

The roadmap acknowledges that DKA risk mitigation protocols exist but notes that rigorous, real-world data on their effectiveness is still needed. This gap underscores why the path forward requires not just scientific innovation, but also practical safety strategies that can be implemented reliably in clinical settings.

The publication of this roadmap signals that the type 1 diabetes research community is serious about advancing SGLT inhibitors. However, a roadmap is just the first step. The next phase involves regulatory discussion, funding for appropriately designed trials, and continued collaboration among researchers, clinicians, and the people who will ultimately use these medications.

For people with type 1 diabetes concerned about heart and kidney health, this represents a concrete step toward expanding treatment options—but one that prioritizes safety and rigorous evidence over speed.

Origin: breakthrought1d.org (News report). Evidence: News report, corroborated with 2 indexed studies. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.