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Noninsulin Therapies in Type 1 Diabetes: Adjunctive Role

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Dr Gagan Priya, Mohali    01 February 2018

targets and experience periods of hyperglycemia as well as hypoglycemia. Weight gain, severe hypoglycemia, recurrent hypoglycemia, hypoglycemia unawareness and poor postprandial glycemic control remain significant challenges. Type 1 diabetes is characterized by a-cell dysfunction and glucagon dysregulation. Insulin resistance has been documented in individuals with type 1 diabetes. Non-insulin antidiabetic medications have been explored for their role as adjunctive to insulin therapy to improve metabolic control in type 1 diabetes. Pramlintide, an amylin analogue, is currently approved as adjunctive therapy in type 1 diabetes. The role of metformin has also been evaluated. Metformin reduces insulin dose requirement, weight and LDL-C, reduces maximal CIMT and may extend cardioprotective benefits in type 1 diabetes. Trials of GLP-1 receptor agonists have demonstrated small reductions in HbA1c levels accompanied with weight loss and reduced insulin dose, but a significantly increased risk of hypoglycemia. SGLT2 inhibitors have shown improved glycemic control with reduction in insulin dose and weight in small studies. Dual SGLT2 and SGLT1 inhibitor, sotagliflozin, is under development.

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