The treatment of type 1 diabetes mellitus with agents approved for type 2 diabetes mellitus.
BACKGROUND
The management of type 1 diabetes remains a challenge for clinicians. Current practice is to administer insulin analogues to best mimic normal physiological insulin profiles. However, despite our best efforts the majority of individuals with type 1 diabetes continue to suffer from suboptimal glucose control, significant hypoglycemia and microvascular tissue complications of the disease. There is thus a significant unmet need in the treatment of T1DM to obtain better glycemic control.


METHODS
We discuss the use of α-glucosidase inhibitors, dipeptidyl-peptidase inhibitors, glucagon-like peptide 1 agonists, biguanides, thiazolidinediones and sodium glucose co-transporter 2 inhibitors in individuals with T1DM.


CONCLUSIONS
Non-insulin therapies present a unique and exciting adjunctive treatment for individuals with type 1 diabetes. Although data are scarce, the classes of medications discussed help to lower glucose, decrease glycemic excursions and in some cases improve body weight, along with allowing dose reductions in total daily insulin. Glucagon-like peptide 1 agonists and sodium glucose co-transporter 2 inhibitors, in particular, have been demonstrated to provide clinical improvements in individuals with T1DM and we feel their use can be explored in obese, insulin-resistant patients with T1DM, those with frequent and significant glycemic excursions or individuals with persistently elevated hemoglobin A1c.
a 1 University of Maryland School of Medicine, Center for Diabetes and Endocrinology, Division of Endocrinology, Diabetes, and Nutrition , 827 Linden Ave, 2nd Floor, Baltimore, MD 21201, USA.
Kashif M
KM
Munir
b 2 University of Maryland School of Medicine, Department of Medicine , 22 South Greene Street, Baltimore, MD 21201, USA +1 41 03 28 24 88 ; +1 41 03 28 86 88 ; sdavis@medicine.umaryland.edu.
Stephen N
SN
Davis
D001645:Biguanides / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006442:Glycated Hemoglobin / Q000378:metabolism; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D009765:Obesity / Q000188:drug therapy; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones / Q000627:therapeutic use
D001645:Biguanides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D045162:Thiazolidinediones
dipeptidyl-peptidase inhibitor; glucagon-like peptide 1 agonist; metformin; sodium glucose co-transporter 2 inhibitor; type 1 diabetes; α-glucosidase inhibitor