Adjunct Therapies In Type 1 Diabetes

Abstract

The arrival of insulin in 1921 initiated a revolution in the treatment of type 1 diabetes (T1D), as it was the first rational treatment in such patients ( 1. Banting F.G. Best C.H. Internal secretion of pancreas. J Lab Clin Med. 1922; 7: 465-480 Google Scholar ). The dramatic improvements in the clinical condition of these patients led to the most rapid award of a Nobel Prize in medicine in 1923 ( 2. Rosenfeld L. Insulin: discovery and controversy. Clin Chem. 2002; 48: 2270-2288 Crossref PubMed Scopus (176) Google Scholar ). It was expected that all problems of this condition would thus be solved. However, as defined in the article by Bode and Garg in this issue of Endocrine Practice, problems with the management of T1D continue, including the unpredictable variability of blood glucose concentrations, diabetic ketoacidosis (DKA), and long-term micro-angiopathic and macro-angiopathic complications. In addition, a recent study based on the Swedish database demonstrated a marked and alarming increase of mortality in this patient population when compared normal subjects ( 3. Lind M. Svensson A.M. Kosiborod M. et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med. 2014; 371: 1972-1982 Crossref PubMed Scopus (539) Google Scholar ). Clearly, we need to improve upon the current standards of care, as only 20% of this population is at the hemoglobin A1c (HbA1c) goal of <7%. Furthermore, 40 to 50% of patients with T1D now have metabolic syndrome, necessitating the use of adjuvant therapies that have complementary benefits of weight loss, insulin dose reduction, and blood pressure lowering, in addition to glycemic control ( 4. KuhadiyaND, DhindsaS, GhanimH, MehtaA, et al. Liraglutide as additional treatement to insulin in patients with type 1 diabetes mellitus: a randomized placebo-controlled clinical trial. AACE 2014 Late Breaking Abstract. Google Scholar ).