Reducing Type 1 Diabetes Mortality: Role for Adjunctive Therapies?
Abstract
Individuals with type 1 diabetes (T1D) frequently fail to achieve glycemic goals and have excess cardiovascular risk and premature death. Adjunctive agents may play a role in reducing morbidity, mortality, and the adverse sequelae of insulin treatment. A surge in type 2 diabetes drug development has revealed agents with benefits beyond glucose lowering, including cardiovascular risk reduction. Could these benefits translate to T1D? Specific trials for T1D demonstrate substantial hemoglobin (Hb)A1c reductions with sodium glucose cotransporter inhibitors (SGLTis) and glucagon-like peptide (GLP)1 agonists, and modest improvements with metformin, dipeptidyl peptidase-4 inhibitor (DPP4i), and pramlintide. Studies exploring cardiovascular risk reduction are warranted. This review synthesizes the emerging literature for researchers and clinicians treating people with T1D. Challenges in T1D research are discussed.
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In phase III programs in people with type 1 diabetes, SGLT-1 or SGLT-1/2 inhibitors reduced HbA1c, improved TIR, reduced body weight, and improved blood pressure.
“In several phase III programs in people with type 1 diabetes, the use of SGLT-1 or SGLT-1/2 inhibitors reduced HbA 1c , improved TIR, reduced body weight, and improved blood pressure (244).”
Metformin has been evaluated in numerous small trials in people with type 1 diabetes with hopes that its insulin-sensitizing properties would improve glycemic management and/or reduce cardiovascular risk.
“Metformin has been evaluated in numerous small trials in people with type 1 diabetes with hopes that its insulin-sensitizing properties would improve glycemic management and/or reduce cardiovascular risk (244,245).”
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References 97 · Cited by 45
- Authors
- Snaith, J. R., Holmes-Walker, D. J., & Greenfield, J. R.
- Affiliations
- The University of Sydney (AU)
- Garvan Institute of Medical Research (AU)
- Corresponding author
- Greenfield, Jerry R.
- Venue
- Trends in Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 31
- Issue
- 2
- Pages
- 150-164
- ISSN
- 1043-2760 (ISSN-L)
- OpenAlex
- W2992847844
- Cited by
- 45
- References
- 97
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 9 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 5
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Trends in Endocrinology and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of New South Wales
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, mortality reduction, adjunctive therapy, glycemic control, cardiovascular risk, sodium-glucose cotransporter inhibitors, GLP-1 receptor agonists, metformin, DPP-4 inhibitors, pramlintide, HbA1c
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Metformin, Outcome Assessment, Health Care, Incretins
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