Reducing Type 1 Diabetes Mortality: Role for Adjunctive Therapies?

Jennifer R Snaith; Deborah J Holmes-Walker; Jerry R Greenfield

doi:10.1016/j.tem.2019.11.007

Reducing Type 1 Diabetes Mortality: Role for Adjunctive Therapies?

Trends Endocrinol Metab. 2020 Feb;31(2):150-164. doi: 10.1016/j.tem.2019.11.007. Epub 2019 Dec 7.

Authors

Jennifer R Snaith¹, Deborah J Holmes-Walker², Jerry R Greenfield³

Affiliations

¹ Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
² Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
³ Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: j.greenfield@garvan.org.au.

PMID: 31822381
DOI: 10.1016/j.tem.2019.11.007

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.

Keywords: adjunctive treatment; cardiovascular risk; type 1 diabetes.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Diabetes Mellitus, Type 1 / drug therapy*
Diabetes Mellitus, Type 1 / mortality
Humans
Hypoglycemic Agents / pharmacology*
Incretins / pharmacology*
Metformin / pharmacology*
Outcome Assessment, Health Care*
Sodium-Glucose Transporter 2 Inhibitors / pharmacology*

Substances

Hypoglycemic Agents
Incretins
Sodium-Glucose Transporter 2 Inhibitors
Metformin