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Reducing Type 1 Diabetes Mortality: Role for Adjunctive Therapies?

Jennifer R Snaith1, Deborah J Holmes-Walker2, Jerry R Greenfield3

  • 1Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.

Trends in Endocrinology and Metabolism: TEM
|December 12, 2019
PubMed

Insights

Adjunctive diabetes medications show promise for type 1 diabetes (T1D) management. Sodium glucose cotransporter inhibitors and GLP-1 agonists significantly reduce HbA1c, with further research needed for cardiovascular benefits.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Type 1 diabetes (T1D) management often fails to meet glycemic targets, leading to increased cardiovascular risk and mortality.
  • Adjunctive therapies beyond insulin are being explored to mitigate T1D complications.
  • Recent advances in type 2 diabetes pharmacotherapy offer potential benefits for T1D treatment.

Purpose of the Study:

  • To review the emerging literature on adjunctive agents for T1D.
  • To assess the efficacy of various drug classes in improving glycemic control in T1D.
  • To highlight the need for cardiovascular outcome studies in T1D using these agents.

Main Methods:

  • Literature synthesis of clinical trials and research studies involving T1D patients.
  • Analysis of data on hemoglobin A1c (HbA1c) reductions with different pharmacological classes.
  • Discussion of challenges inherent in T1D clinical research.

Main Results:

  • Sodium glucose cotransporter inhibitors (SGLTIs) and glucagon-like peptide (GLP)-1 agonists demonstrate significant HbA1c reductions in T1D.
  • Metformin, dipeptidyl peptidase-4 inhibitors (DPP4i), and pramlintide show modest improvements in glycemic control.
  • Evidence for cardiovascular risk reduction in T1D with these agents is currently limited.

Conclusions:

  • Adjunctive agents, particularly SGLTIs and GLP-1 agonists, offer substantial glycemic benefits for individuals with T1D.
  • Further investigation into the cardiovascular effects of these therapies in T1D is crucial.
  • Addressing research challenges is essential for advancing T1D treatment strategies.
Keywords:
adjunctive treatmentcardiovascular risktype 1 diabetes

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