Non-insulin therapies in management of type 1 diabetes.

IF 4.6 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Zeb I Saeed, Jayachidambaram Ambalavanan, Melanie Natasha Rayan, Palak Patadia, Viral N Shah
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Abstract

With increasing prevalence of double diabetes (features of type 2 diabetes in people with type 1 diabetes (T1D)), there is a growing interest in using non-insulin therapies to improve glycemic outcomes, promote weight loss, and reduce cardiovascular risk in T1D. In this narrative review, we summarize current literature and provide practical guidance for clinicians when considering these therapies. Using a PubMed literature search, we identified 51 randomized clinical trials investigating sodium glucose co-transporter inhibitors (SGLTi :9), glucagon like peptide 1 receptor agonist (GLP1RA: 13), metformin (13), dipeptidyl peptidase-4 inhibitor (DPP-4i: 9), pramlintide (4), bromocriptine (1) and combination therapies (2) in T1D. Outcomes of interest included change in HbA1c, weight, total daily dose (TDD) of insulin, surrogate cardiovascular outcomes and safety parameters. Data shows that GLP-1RAs and SGLTi have demonstrated the greatest efficacy in reducing HbA1c up to 0.7% and 0.5% respectively compared to placebo. GLP-1RAs reduced TDD of insulin by up to 18.5% and weight up to 9.3% (8.3kg). SGLTi reduced insulin TDD by up to 15.3% and weight 5.3% (4.3kg). Neither class increased the risk of severe hypoglycemia but SGLTi had a two-to-fivefold higher risk of diabetic ketoacidosis (DKA). Other agents (metformin, DPP-4i and bromocriptine) failed to demonstrate a sustained glycemic efficacy in T1D. In summary, GLP-1RA has a great potential as adjunct therapy in T1D. SGLTi could be another beneficial therapy in T1D, however, more research is needed to improve DKA risk with this therapy. Efficacy trials of weekly GLP-1RA and its potential cardio-renal benefits in T1D are much needed.

1型糖尿病的非胰岛素治疗
随着双重糖尿病(2型糖尿病合并1型糖尿病(T1D)的特征)患病率的增加,人们对使用非胰岛素治疗来改善血糖结局、促进体重减轻和降低T1D患者心血管风险的兴趣越来越大。在这篇叙述性综述中,我们总结了目前的文献,并为临床医生在考虑这些治疗方法时提供了实用的指导。通过PubMed文献检索,我们确定了51项随机临床试验,研究了葡萄糖共转运蛋白抑制剂钠(SGLTi:9)、胰高血糖素样肽1受体激动剂(GLP1RA: 13)、二甲双胍(13)、二肽基肽酶-4抑制剂(DPP-4i: 9)、普兰林肽(4)、溴啡肽(1)和T1D联合治疗(2)。关注的结果包括HbA1c、体重、胰岛素总日剂量(TDD)、替代心血管结局和安全性参数的变化。数据显示,与安慰剂相比,GLP-1RAs和SGLTi在降低HbA1c方面的疗效最大,分别达到0.7%和0.5%。GLP-1RAs降低胰岛素的TDD高达18.5%,体重高达9.3% (8.3kg)。SGLTi可使胰岛素TDD降低15.3%,体重降低5.3% (4.3kg)。两类药物均未增加严重低血糖的风险,但SGLTi的糖尿病酮症酸中毒(DKA)风险高出2 - 5倍。其他药物(二甲双胍、DPP-4i和溴隐肽)在T1D中未能显示出持续的降血糖功效。综上所述,GLP-1RA作为T1D的辅助治疗具有很大的潜力。SGLTi可能是T1D的另一种有益的治疗方法,然而,需要更多的研究来提高这种治疗的DKA风险。迫切需要每周GLP-1RA的疗效试验及其对T1D的潜在心脏和肾脏益处。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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