Transcript Type 1 Diabetes Treatment Options, Part 5

Type 1 Diabetes
Treatment Options
Part 5
Stanley Schwartz
Emeritus, Univ of Pa
Mark Stolar
Potential Adjunctive Treatments
for Type 1 Diabetes
Incretins
SGLT-2 Inhibitors
Insulin Sensitizers
Potential for Incretin Rx in T1DM
3
Drug Discovery Today Volume 17, Numbers 1/2 January 2012
Incretin Therapy in Type 1 Diabetes
Improved glycemic variability
Liraglutide
Data Suggests: less
Vildigliptin
dawn effect, less variability,
decrease insulin doses, less hypoglycemia
Potential Adjunctive Treatments
for Type 1 Diabetes
Incretins
SGLT-2 Inhibitors
Insulin Sensitizers
Mechanism of Action of SGLT-2 Inhibition
SGLT-2 Inhibition
SGLT-2 Inhibition in T1DM
In 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
Incretins
SGLT-2 Inhibitors
Insulin Sensitizers
Multiple Causes IRType 1 Patients can have Insulin Resistance
- Identify by Insulin need > ~50u/day
Weight Reduction
Agents
Biome
ProIR
Biotics,
Pre-Biotics,
Antibiotics
Central IR/
Appetite
Peripheral
IR
TZD (Pio-)
Metformin
Bromocriptine-QR
Inflammation
IR
AntiInflam.
Pioglitazone
Metformin
Multiple studies show benefits, albeit to
different degrees in different patients
1.
Decreased HgA1c
2.
Decreased Weight
3.
Decreased Insulin requirements
4.
Decreased FBS, PPG
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
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 Practice
1-16,2014,DOI: 10.1177/0897190014549837
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 Diabetes
Non-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
11