Adjunct therapies in treatment of type 1 diabetes

J Diabetes. 2020 Oct;12(10):742-753. doi: 10.1111/1753-0407.13078. Epub 2020 Sep 9.

Abstract

In spite of developments with novel insulin preparations, novel modes of insulin delivery with insulin infusion pumps, and the facility of continuous glucose monitoring, only 20% of patients with type 1 diabetes are under adequate control. The need for innovation is clear, and, therefore, the use of adjunct therapies with other pharmacological agents currently in use for type 2 diabetes, has been tried. Currently, pramlintide is the only agent licensed for use in this condition in addition to insulin. Global trials have been conducted with liraglutide, a glucagon-like peptide 1 receptor agonist (GLP-1RA), dapagliflozin, a sodium glucose cotransporter 2 (SGLT2) inhibitor, and sotagliflozin, an inhibitor of both SGLT1 and SGLT2 transporters. While dapagliflozin and sotagliflozin have now been licensed for clinical use in this condition in Europe and Japan, they have hitherto not been licensed in the United States due to a small increase in the risk of diabetic ketoacidosis. However, these agents reduce glycosylated hemoglobin (HbA1c) by 0.4%, reduce glycemic oscillations, and do not increase the risk of hypoglycemia. Liraglutide, on the other hand, induced a smaller reduction in HbA1c and thus was not considered for a license. However, further trials are currently being conducted with a combination of semaglutide, the most potent GLP-1RA, and dapagliflozin to determine whether this approach would yield better outcomes.

尽管有了新的胰岛素制剂, 以及胰岛素输注泵等新的给药方式和连续血糖监测设备的发展, 但只有20%的1型糖尿病患者得到充分的控制, 进一步革新的必要性是显而易见的。因此, 已有研究尝试了将2型糖尿病药物用于1型糖尿病的辅助疗法。目前, 普拉林肽是除胰岛素外唯一获准在这种情况下使用的药物。胰高血糖素样肽1受体激动剂(GLP-1RA)利拉鲁肽、钠葡萄糖共转运体2(SGLT2)抑制剂达格列净, 以及SGLT1和SGLT2转运体抑制剂索格列净已经进行了全球试验。虽然达格列净和索格列净已经在欧洲和日本获得在这种情况下的临床使用许可, 但由于糖尿病酮症酸中毒风险的小幅增加, 这些药物到目前为止还没有在美国获得许可(在1型糖尿病中的应用)。然而, 这些药物能够将糖化血红蛋白(HbA1c)水平降低0.4%, 减少了血糖波动, 并且不会增加低血糖的风险。另一方面, 利拉鲁肽降低糖化血红蛋白(HbA1c)的幅度较小, 因此并未考虑其(在1型糖尿病中的)使用许可。然而, 目前正在进行进一步的试验, 将最有效的胰高血糖素样肽1受体激动剂索马鲁肽和达格列净联合使用, 以确定这种方法是否会产生更好的结果。.

Keywords: 1型糖尿病; GLP-1 receptor agonists; GLP-1受体激动剂; SGLT inhibitors; SGLT抑制剂; pramlintide; type 1 diabetes; 普拉林肽.

Publication types

  • Review