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The changing therapeutic armamentarium for patients with type 1 diabetes
1MCPHS University, Keck School of Medicine, University of Southern California.
Purpose Of Review:
This article evaluates the role of Sodium glucose co-transporter-2 (SGLT-2) inhibitor and Glucagon-like peptide-1 receptor agonist's (GLP-1 RA's)s in the treatment of type 1 diabetes (T1D).
Recent Findings:
Both agents help to produce a small reduction in HbA1C levels with accompanying weight loss. Submaximal doses of SGLT-2 inhibitors may reduce the risk for hypoglycemia as well as limit glycemic variability. However, SGLT-2 inhibitors appear to increase rates of ketone body production and diabetic ketoacidosis, and therefore must only be used in the setting of appropriate risk mitigation. GLP-1 RA's increased the risk for hypoglycemia in the largest clinical trial done to date (with a small fall in A1C), which lead to a cessation of the development of liraglutide as a treatment for T1D.
Summary:
Off-label use of medications designed for individuals with type 2 diabetes in people with T1D has potential benefits as well as risks. If using an SGLT-2 inhibitor or a GLP-1 RA, it is important to have an informed, educated patient and follow a specific protocol. In the case of SGLT-2 inhibitors, clinical trials should help define how to use these agents more safely and effectively in T1D.
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