Abstract
Obesity prevalence in T1DM is increasing. While T1DM is typically treated exclusively with insulin, the changing obesity trends and T1DM heterogeneity has raised interest in use of various oral hypoglycemic agents (OHA) as adjunctive therapy. The extent and impact of OHA “off label” use in “real world” settings is not well studied. We report on the extent, distribution, glycemic and cardiometabolic impact of OHA use in a T1DM cohort. Retrospective chart review of 300 patients with health record coded T1DM seen between January 2015 and January 2018 was done. OHA use, comorbidities, demographics, vital signs, and cardiometabolic risk surrogates were extracted for analyses.. The chart review showed actual DM subtypes were :163 (54%) T1DM, 43 (14.3%) Latent Autoimmune Diabetes of Aging (LADA), 1 (0.3%) maturity-onset diabetes of the young, 2 (0.7%) type 1.5 (essentially LADA), 8 (2.7%) type 1+2 (T1DM with obesity and insulin resistance), 11 (3.7%) deceased, and 71 (23.7%) T2DM that had been miscoded as T1DM. All subsequent analyses included T1DM, LADA, type 1.5, and type 1+2 in the verified T1DM cohort. 16% of the T1DM cohort were on at least one OHA and most common were sulphonylureas (16%), DPP-4 blockers (15.3%), SGLT-2 blockers (11%) and metformin (9.2%). OHA use in T1DM was not associated with any significant change in weight, BMI nor blood pressure. There was however a statistically significant decline in total cholesterol, LDL and HBA1c but not fasting triglycerides. No significant differences were found in hypoglycemia related admissions or DKA admissions with OHA use including among SGLT-2 users. Off label use of OHAs is quite prevalent in the studied population of patients with T1DM (16%) and their use was associated with improvements in HBA1c and aspects of lipid metabolism despite no significant changes in weight, BMI or blood pressure. OHAs may have utility as adjunctive therapy and require more structured study to enable development of therapeutic algorithms for their use in T1DM therapeutics. Disclosure K. G. Romo: None. W. A. West: None. G. I. Uwaifo: None.
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