Seeking non-insulin therapies for Type 1 Diabetes

Seventy percent of people with type 1 diabetes (T1D) are unable to achieve an HbA1C measurement of less than 7 for adults and 7.5 for those younger than 18—the gold standard for good blood-sugar management in people with diabetes. Most rely solely on insulin to control their glucose levels, but a growing number of researchers and medical professionals are exploring whether non-insulin drugs such as GLP-1 agonists and SGLT2 inhibitors—approved for treatment of type 2 diabetes (T2D)—could be paired with insulin to better manage T1D.

This interest was underscored during the recent Rachmiel Levine – Arthur Riggs Diabetes Research Symposium, where diabetes experts Anne Peters, M.D., from the University of Southern California’s Keck School of Medicine, and David Nathan, M.D., with Massachusetts General Hospital, debated the pros and cons of adjunct therapies.

“Diabetes isn’t a one-hormone disease. It affects glucagon and amylin, and it can also bring on metabolic syndrome, causing people to gain weight and putting them at risk for other problems,” said. Dr. Peters. She noted that early studies suggest that SGLT2 inhibitors can help people with T1D achieve better glycemic control and reduce their insulin dosing.

But as Dr. Nathan pointed out, the study also shows that use of SGLT2 inhibitors comes with risks such as increased rates of diabetic ketoacidosis in people with T1D. Research into other potential adjunct therapies has shown benefits such as weight loss, but not HbA1C improvement. He argued that greater use of newer insulins such as rapid-acting formulations and development of more advanced ones such as glucose-responsive insulins are better approaches to helping people with T1D achieve improved outcomes.

The debate highlighted a fact that JDRF has long recognized: T1D is a unique disease for every person who has it, and we need multiple therapeutic options since what works well for one may not be effective or safe for another. This thinking has led to JDRF’s multiple-shots-on-goal approach to funding research that may help us find better ways to treat T1D while we continue working toward prevention and a cure.  Our work includes supporting research into whether SGLT2 inhibitors and GLP-1 agonists can be safely and effectively used to help people with T1D achieve healthier blood sugar levels  and a partnership with pharmaceutical company Sanofi to support development of glucose-responsive insulins, among other efforts.

“We have to individualize therapy for each person and see what drugs may help address their issues,” said Dr. Peters.