Non-insulin pharmacological therapies for treating type 1 diabetes

Expert Opin Pharmacother. 2018 Jun;19(9):947-960. doi: 10.1080/14656566.2018.1483339.


Introduction: Despite intensified insulin treatment, many persons with type 1 diabetes (T1D) do not achieve glycemic and metabolic targets. Consequently, non-insulin chemical therapies that improve glycemic control and metabolic parameters without increasing the risk of adverse events (including hypoglycemia) are of interest as adjunct therapies to insulin.

Areas covered: In this review, the authors discuss the efficacy and safety of non-insulin therapies, including pramlintide, glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 inhibitors (DPP-4), sodium-glucose cotransporter (SGLT1 and SGLT2) inhibitors, metformin, sulfonylureas, and thiazolidinediones as add-on therapies to insulin in T1D.

Expert opinion: The current evidence shows that the efficacy of non-insulin therapies as add-on therapies to insulin is minimal or modest with an average HbA1c reduction of 0.2-0.5% (2-6 mmol/mol). Indeed, the current focus is on the development of SGLT inhibitors as adjuncts to insulin in type 1 diabetes. Studies of subgroups with obesity, residual beta-cell function (including newly diagnosed patients) and patients prone to hypoglycemia could be areas of future research.

Keywords: DPP-4; GLP-1RA; SGLT-1; SGLT-2; SU; T1D; T1DM; TZD; Type 1 diabetes; amylin; dipeptidyl peptidase-4 inhibitor; glucagon-like peptide-1; metformin; pramlintide; sodium-glucose cotransporters; sulfonylurea; thiazolidinediones.

Publication types

  • Review

MeSH terms

  • Clinical Trials as Topic
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Gastrointestinal Diseases / etiology
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Islet Amyloid Polypeptide / therapeutic use
  • Metformin / therapeutic use
  • Sulfonylurea Compounds / therapeutic use
  • Thiazolidinediones / therapeutic use


  • Dipeptidyl-Peptidase IV Inhibitors
  • Hypoglycemic Agents
  • Islet Amyloid Polypeptide
  • Sulfonylurea Compounds
  • Thiazolidinediones
  • Metformin
  • pramlintide