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Adjuvant Pharmacotherapies to Insulin for the Treatment of Type 1 Diabetes

Abstract

Purpose of Review

Insulin therapy alone fails to achieve target glycemic control in the majority of individuals with type 1 diabetes (T1D), motivating the investigation of additive medications. This review focuses on the recent findings on the use of adjunctive pharmacotherapy in T1D.

Recent Findings

Metformin and glucagon-like peptide-1 receptor agonists have been associated with weight reduction and decrease in daily insulin requirements without sustainable improvement in glycemic control. Sodium-glucose cotransporter (SGLT)-2 inhibitors, dual SGLT-1/2 inhibitors, and pramlintide have been shown to reduce hemoglobin A1c, induce weight loss, and lower insulin dose. The benefits of dipeptidyl peptidase-4 inhibitors, thiazolidinediones, and alpha glucosidase inhibitors appear to be more limited. Gastrointestinal symptoms and increased hypoglycemia are adverse effects of certain classes.

Summary

Although not devoid of side effects, additive pharmacotherapies in T1D can improve glycemic control and lower body weight and insulin requirement. Longer studies are needed before consideration for widespread clinical care.

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Acknowledgments

The authors thank Dr. B. Lee Ligon of the Department of Pediatrics Center for Research, Innovation and Scholarship, Baylor College of Medicine, for editorial assistance.

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Correspondence to Mustafa Tosur.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes

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Tosur, M., Redondo, M.J. & Lyons, S.K. Adjuvant Pharmacotherapies to Insulin for the Treatment of Type 1 Diabetes. Curr Diab Rep 18, 79 (2018). https://doi.org/10.1007/s11892-018-1041-1

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Keywords

  • Type 1 diabetes
  • Adjuvant therapy, metformin
  • GLP-1 receptor agonists
  • SGLT-2 inhibitors
  • SGLT-1/2 inhibitors