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Play the video to watch Professor Thomas Danne discussing adjunct therapies
Now let’s take a look at the possibilities that we have for adjunct therapies to insulin. Obviously, type 1 diabetes always needs insulin therapy because you have a complete insulin deficiency. So, all these therapies would be adjunct therapies to insulin. Metformin was tried and, particularly in obese patients with type 1 diabetes, there was a lot of discussion that it might actually improve things but in recent trials, particularly the REMOVAL study, showed there wasn’t a real improvement. There was then debate over whether metformin actually improves the long-term cardiovascular outcomes of type 1 diabetes. This still needs to be discussed, but the current guidelines do not recommend metformin as a general possibility for adjunct therapy. The same goes for the amylin analogues. This is actually approved in the United States but since there is an increased risk of hypoglycaemia and you have to take an extra injection, this is a therapy that has not really become clinically meaningful. GLP-1 agonists or DPP-4 inhibitors? The studies don’t really show much of an improvement, so this is not a therapy that is currently recommended – leaving the group of SGLT-2 inhibitors as a novel idea for improving glycaemic control on top of insulin. Because these therapies have an insulin-independent mode of action, and actually through this mode of action do not increase the hypoglycaemia risk, and may have added benefits in terms of cardiovascular improvement, as has been shown in type 2 diabetes. They may even improve weight and also have positive effects in terms of renal risk factors in type 1 diabetes.
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George P, McCrimmon RJ. Potential role of non-insulin adjunct therapy in Type 1 diabetes. Diabet Med. 2013 Feb;30(2):179-88.
http://www.ncbi.nlm.nih.gov/pubmed/22804102

McCrimmon RJ, Henry RR. SGLT inhibitor adjunct therapy in type 1 diabetes. Diabetologia. 2018 Oct;61(10):2126-2133.
http://www.ncbi.nlm.nih.gov/pubmed/30132030