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The Horizon Ahead: Emerging Adjunctive Therapies for Type 1 Diabetes
Vala Hamidi1, Jeremy H Pettus1
1Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA, USA; Altman Clinical and Transational Research Institute (ACTRI), 9452 Medical Center Drive, L1W-515, La Jolla, CA 92037, USA.
Endocrinology and Metabolism Clinics of North America
|July 29, 2026
Summary
This perspective proposes a clinical roadmap for type 1 diabetes management, integrating new metabolic therapies beyond insulin to address cardiometabolic risk and glycemic variability.
Area of Science:
- Endocrinology and Metabolism
- Diabetes Care
Background:
- Type 1 diabetes management faces persistent challenges in cardiometabolic risk, weight gain, and glycemic variability despite advances in insulin therapy and technology.
- Current treatment paradigms primarily rely on insulin, necessitating exploration of adjunctive strategies.
Purpose of the Study:
- To outline a clinical roadmap for integrating adjunctive metabolic therapies into type 1 diabetes care.
- To propose an evidence-based approach expanding treatment beyond insulin alone.
Main Methods:
- A perspective outlining a clinical roadmap based on an "metabolic therapy tree" approach.
- Categorization of therapies into "low-hanging fruit," "slightly higher fruit," and "emerging targets."
Main Results:
- Identified "low-hanging fruit" therapies: incretin-based therapies and amylin analogs.
- Highlighted "slightly higher fruit" therapies: sodium-glucose linked transporter inhibitors (SGLTIs) with safety engineering and continuous ketone monitoring.
- Noted emerging targets: glucagon modulation and fibroblast growth factor 21 (FGF21) analogs.
Conclusions:
- Adjunctive metabolic therapies offer a promising avenue to improve type 1 diabetes management beyond insulin.
- A structured, evidence-based approach is crucial for integrating these novel therapies into clinical practice.
- Future research and technological advancements (e.g., continuous ketone monitoring) are essential for unlocking the full potential of therapies like SGLTIs.
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