title: Alternative Agents in Type 1 Diabetes in Addition to Insulin Therapy: Metformin, Alpha-Glucosidase Inhibitors, Pioglitazone, GLP-1 Agonists, DPP-IV Inhibitors, and SGLT-2 Inhibitors.
abstract: Insulin is the mainstay of current treatment for patients with type 1 diabetes mellitus (T1DM). Due to increasing insulin resistance, insulin doses are often continually increased, which may result in weight gain for patients. Medications currently approved for the treatment of type 2 diabetes offer varying mechanisms of action that can help to reduce insulin resistance and prevent or deter weight gain. A MEDLINE search was conducted to review literature evaluating the use of metformin, alpha-glucosidase inhibitors, pioglitazone, glucagon-like peptide 1 agonists, dipeptidyl peptidase, and sodium-dependent glucose transporter 2 inhibitors, in patients with T1DM. Varying results were found with some benefits including reductions in hemoglobin A1c, decreased insulin doses, and favorable effects on weight. Of significance, a common fear of utilizing multiple therapies for diabetes treatment is the risk of hypoglycemia, and this review displayed limited evidence of hypoglycemia with multiple agents.
authors.affiliation: Department of Pharmacy, Wingate University, Hendersonville, NC, USA m.degeeter@wingate.edu.
authors.forename: Michelle
authors.initials: M
authors.lastname: DeGeeter
authors.affiliation: Department of Pharmacy, Wingate University, Hendersonville, NC, USA.
authors.forename: Bobbie
authors.initials: B
authors.lastname: Williamson
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D052216:Glucagon-Like Peptide 1 / Q000819:agonists / Q000627:therapeutic use*; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use*; D000077205:Pioglitazone; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones / Q000627:therapeutic use*
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007328:Insulin; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones; D052216:Glucagon-Like Peptide 1; D008687:Metformin; D000077205:Pioglitazone
keywords: HbA1c; hypoglycemia; insulin; type 1 diabetes; weight gain