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Adjunct therapy in type 1 diabetes - conclusions

Play the video to hear Professor Thomas Danne concluding this module
To sum up this section about adjunct therapy in type 1 diabetes, I think it becomes quite clear that with the current means of therapy, we are not achieving the goal that we would like. There is still a considerable increase in cardiovascular mortality and long-term complications, even in those patients who are achieving near normal glycaemia and their targets. And we must be aware that many of the patients, even with the use of newer technologies, are not achieving those targets. In order to improve the prognosis, we of course need insulin but also adjunct therapy in addition to insulin. Currently, there is study evidence that SGLT-2 inhibitors – sodium glucose transport inhibitors-2 and 1 and 2 – are the most promising agents to do so and have been recently recommended for approval. The reason for that is that they not only improve glycaemic control, but they also may have positive effects on weight, they might have positive effects on blood pressure and they’re doing all this without increasing your risk of hypoglycaemia. But this has to be balanced, because these drugs are increasing the risk of diabetic ketoacidosis. So, one way is, of course, you have to select the right patients – patients that are not at increased risk of DKA as such – and we have to implement DKA risk mitigation strategies, both in the individual patients, the caregivers and the medical community at large in order to make this a promising adjunct therapy.
  • Achievement of sustained glycaemic control remains a challenge for many patients with type 1 diabetes (T1D)
  • Non-insulin–based adjunct treatments offer the potential to complement intensive insulin therapy with multiple daily insulin injections or continuous glucose monitoring in T1D
  • Sodium glucose co-transporter SGLT-2 or -1 & -2 inhibitors represent one possible class of adjunct agents:
    • Insulin-independent mechanism of action leading to more time in range and less glycaemic variability
    • Weight benefits
    • Potential for preservation of beta-cell function by overcoming glucose toxicity
    • Possible renal protection
    • Possible cardiovascular risk reduction

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http://www.ncbi.nlm.nih.gov/pubmed/25583754

Idris I, Donnelly R. Sodium-glucose co-transporter-2 inhibitors: an emerging new class of oral antidiabetic drug. Diabetes Obes Metab. 2009 Feb;11(2):79-88.
http://www.ncbi.nlm.nih.gov/pubmed/19125776

Musso G, Cassader M, Rosina F, Gambino R. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia. 2012 Apr;55(4):885-904.
http://www.ncbi.nlm.nih.gov/pubmed/22278337

Panchapakesan U, Pegg K, Gross S, Komala MG, Mudaliar H, Forbes J, Pollock C, Mather A. Effects of SGLT2 inhibition in human kidney proximal tubular cells--renoprotection in diabetic nephropathy? PLoS One. 2013;8(2):e54442
http://www.ncbi.nlm.nih.gov/pubmed/23390498