The American Diabetes Association’s Scientific Sessions is here! Until June 16, scientists will present some of the most updated topics, from beta cell replacement to regeneration and glucose and complications trials, all with the result to change things for the type 1 diabetes (T1D) community. Here is Dr. Chantal Mathieu to share her key takeaways from day 3, with her commentary in the video and below:
Chantal Mathieu, M.D., Ph.D.
Adjunctive Glucose-Lowering Therapies for Adults with T1D—Evidence
Dr. Chantal Mathieu gave an update on where we are with three classes of glucose-lowering therapies, usually used for type 2 diabetes (T2D), but increasingly used for T1D: metformin, GLP-1 receptor agonists and SGLT inhibitors. She went into adjunct therapies, and why they are needed: many people do not reach their desired HbA1c target, we still have hypoglycemia occurring in many people and there is undesired weight gain in intensive insulin therapy. Metformin, which was presented by Irene Hramiak, M.D., has been studied for many years now, and there is a clinical trial, called the REMOVAL trial [which Breakthrough T1D funded!], in T1D. Unfortunately, it missed its primary endpoint, but what was observed is some benefit in HbA1c, lower insulin dose and also less weight gain. What do the clinical studies show in GLP-1 receptor agonists? Presented by Tina Vilsbøll, M.D., D.M.Sc., there is a benefit in reducing insulin dose, in reducing HbA1c and also reducing weight, but when the dose of insulin is not reduced rapidly enough, you get more hypoglycemia, which was an unexpected risk, and also an increased risk in ketosis. Dr. Mathieu discussed SGLT inhibitors. Many trials have been done, and in people with T1D, there was HbA1c lowering, weight lowering, blood pressure lowering and also less insulin needed to achieve better HbA1c. But the feared risk is for diabetic ketoacidosis (DKA), which 2%-4% of people in the trials developed (this is the reason why they are not approved by the FDA; in Europe, there is approval for 2 SGLT inhibitors, but at a lower dose than what clinicians are using for T2D).
