The sodium-glucose cotransporter type 1 (SGLT1) is the primary transporter for 
absorption of glucose and galactose in the gastrointestinal tract. Inhibition 
blunts and delays postprandial glucose (PPG) excursion. Sodium-glucose 
cotransporter type 2 (SGLT2) is expressed in the kidney, where it reabsorbs 90% 
of filtered glucose. Thus, a dual SGLT1 and SGLT2 inhibition (compared with 
selective SGLT2 inhibition) could result in lower PPG and robust A1c reduction 
even in patients with reduced kidney function. Sotagliflozin is an oral potent 
dual inhibitor of the insulin-independent SGLT1 and SGLT2. Preliminary data 
released from phase 2 and 3 clinical studies in adults with type 1 diabetes 
mellitus (T1DM) and type 2 diabetes mellitus (T2DM) showed improved glycemic 
control, and met efficacy endpoints beyond A1c with a safety profile consistent 
with the SGLT class: significant reduction in body weight, systolic blood 
pressure, and efficacy maintained in lower estimated glomerular filtration rate 
levels with no increased hypoglycemia. Increased risk of diabetic ketoacidosis 
(DKA) with uncharacteristically mild-to-moderate glucose elevations (euglycemic 
DKA) is associated with the use of all the approved SGLT2 inhibitors. Factors 
that trigger DKA include insulin reductions, low caloric and fluid intake, 
intercurrent illness, and alcohol use. However, DKA is detectable and manageable 
with proper patient education. With sotagliflozin, DKA rates were not higher 
than the expected background rate in T1DM, but numerically higher than placebo. 
Sotagliflozin is the first oral SGLT1 and SGLT2 inhibitor developed for the 
treatment of adult patients with T1DM, in adjunct with insulin, and has the 
potential to address unmet needs for patients with T1DM and possibly T2DM, with 
a favorable benefit/risk profile.