Type 1 Diabetes Treatment Options
Stanley Schwartz Mark Stolar Emeritus, Univ of Pa
Part 5
Potential Adjunctive Treatments for Type 1 Diabetes
IncretinsSGLT-2 InhibitorsInsulin Sensitizers
Potential for Incretin Rx in T1DM
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Drug Discovery Today Volume 17, Numbers 1/2 January 2012
Incretin Therapy in Type 1 DiabetesImproved glycemic variability
Liraglutide Vildigliptin
Data Suggests: less dawn effect, less variability, decrease insulin doses, less hypoglycemia
Potential Adjunctive Treatments for Type 1 Diabetes
IncretinsSGLT-2 InhibitorsInsulin Sensitizers
Mechanism of Action of SGLT-2 Inhibition
SGLT-2 Inhibition
SGLT-2 Inhibition in T1DMIn Clinical Practice SGLT-2 Inhibition has shown benefits:
decreased variability, especially ppg; with appropriate reduction in insulin dosing-less hypoglycemia
However, few studies done worry about potential for DKA with increased glucagon as response to
glycosuria
Potential Adjunctive Treatments for Type 1 Diabetes
IncretinsSGLT-2 InhibitorsInsulin Sensitizers
Multiple Causes IR-Type 1 Patients can have Insulin Resistance
- Identify by Insulin need > ~50u/day
PeripheralIR
PeripheralIR
Central IR/Appetite
Central IR/Appetite
Inflam-mation
IR
Inflam-mation
IR
BiomeIR
BiomeIR
TZD (Pio-)
Metformin
Bromocriptine-QR
Anti-Inflam.
Pro-Biotics,Pre-Biotics,Antibiotics
Weight ReductionAgents
MetforminMultiple studies show benefits, albeit to different degrees in different patients1.Decreased HgA1c2.Decreased Weight3.Decreased Insulin requirements 4.Decreased FBS, PPG
Alternative Agents in Type 1 Diabetes in Addition to Insulin Therapy: Metformin, Alpha-Glucosidase Inhibitors, Pioglitazone, GLP-1 Agonists, DPP-IV Inhibitors, and SGLT-2 Inhibitors ,Michelle DeGeeter, PharmD, CDE1, and Bobbie Williamson, PharmD, BCACP, CDE1 ,Journal of Pharmacy Practice1-16,2014,DOI: 10.1177/0897190014549837
Pioglitazone
Effect of Pioglitazone on the Course of New-Onset Type 1 Diabetes Mellitus J Clin Res Pediatr Endocrinol 2013;5(4):236-239 DOI: 10.4274/Jcrpe.981
Summary• DM control in T1DM decreases adverse outcomes• Albeit at risk of variability, hypo, weight gain• Standard basal-bolus care not ideal• Data exists for those that address hyperglucagonemia
– Pramlintide on label– Incretins based therapy not approved for type 1 DiabetesNon-insulin mediated mechanism of lowering postprandial glucose
in Type 1 diabetes through renal or motility modifying agents has potential to improve glycemic variability and overall diabetic control
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