新型口服降血糖藥物「第二型鈉—葡萄糖轉運蛋白抑制劑」(sodium glucose cotransporters 2 inhibitors, SGLT2i) 有別於其他降血糖藥，數個大型隨機對照試驗接連發現SGLT2i 透過腎臟排糖達到降血糖效果，也具有減重、降血壓及降尿酸作用，甚至降低心血管事件、心衰竭住院率、降低蛋白尿、減緩糖尿病腎臟病變進展，是目前為止唯一有充足證據顯示具有心腎保護作用的降血糖藥物。然而，SGLT2i 治療第二型糖尿病也有其風險存在，如嚴重生殖及泌尿道感染、酮酸中毒 (diabetic ketoacidosis, DKA)，甚至增加下肢截肢率。第一型糖尿病 (type 1 diabetes, T1D) 因自體免疫攻擊胰臟中製造胰島素的β 細胞，導致胰島素完全缺少，這些患者須終生注射胰島素，且長期注射胰島素造成體重增加，以及患者可能未規律注射胰島素而有DKA 風險。近年來研究發現，T1D 患者除了使用注射型胰島素治療，額外給予SGLT2i，可使T1D 患者每日胰島素所需總量 (total daily dose, TDD) 減少及體重下降，同時達到較好的血糖目標。因此本文將藉由文獻探討SGLT2i 做為T1D 輔助治療的挑戰。

The novel oral hypoglycemic drugs “sodium glucose co-transporters 2 inhibitors”(SGLT2i) are different from other hypoglycemic drugs. Several large-scale randomized controlled trials had found that through renal excretion of sugar, SGLT2i achieved glucose lowering and following effects, such as reductions in weight, blood pressure, and uric acid, even reduced cardiovascular events and heart failure hospitalization, reduced albuminuria, and slowed down diabetic nephropathy progression. It was so far the only hypoglycemic drug with sufficient evidence to show cardio-renal protection. However, SGLT2i treatment for type 2 diabetes also has its risk, such as severe genital and urinary tract infections, diabetic ketoacidosis (DKA), and even increased risk of lower limb amputation. In type 1 diabetes (T1D) patients, because autoimmune attacking on the β-cells, the insulin maker in the pancreas, caused a complete lack of insulin, they needed insulin injection for lifelong. Long-term injection of insulin caused weight gain, and if T1D patients under irregular injection with insulin will be at risk of DKA. In recent years, the studies have found that in addition to insulin injection treatment, SGLT2i can be added to T1D treatment to reduce the total daily doses (TDD) of insulin and also benefit weight loss to achieve a better blood sugar control. This article intended to discuss the challenges of SGLT2i as adjunctive therapy for T1D through the literature review.