Type 1 Diabetes Treatment Options Part 5 Stanley

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 T 1 DM 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 in T 1 DM 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 > ~50 u/day Weight Reduction Agents Biome Pro. IR Biotics, Pre-Biotics, Antibiotics Central IR/ Appetite Peripheral IR TZD (Pio-) Metformin Bromocriptine-QR Inflammation IR Anti. Inflam.

Pioglitazone Metformin Multiple studies show benefits, albeit to different degrees in different patients 1. Decreased Hg. A 1 c 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 De. Geeter, Pharm. D, CDE 1, and Bobbie Williamson, Pharm. D, BCACP, CDE 1 , Journal of Pharmacy Practice 1 -16, 2014, DOI: 10. 1177/0897190014549837

Summary • • DM control in T 1 DM 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