Are there Adjunctive Therapies for T1D?

Weight gain, hypoglycemia, difficulty achieving A1c goals—these are some of the side effects associated with the intensive insulin therapy it takes to manage type 1 diabetes (T1D). That is why questions about new treatments and additional therapies are often asked when people visit the doctor, said Berrie Center adult endocrinologist Jacqueline Lonier, MD. “Intensive insulin therapy for T1D greatly reduces the long-term risk of diabetes complications, but it is challenging to implement successfully,” she said.

Currently, according to Dr. Lonier, who recently spoke to the Berrie Center staff about “Adjunctive Therapies for T1D,” the only non-insulin agent that is FDA-approved for the treatment of T1D is called Pramlintide. The compound, an amino acid, is taken as an injection at mealtime and is intended to improve glycemic control in conjunction with insulin. 

“Pramlintide is associated with a small A1C reduction and a small amount of weight loss,” added Dr. Lonier, “but it requires multiple additional injections daily and can cause nausea and hypoglycemia. Most patients find that the potential benefits are not worth the burden of additional injections, cost and side effects.” 

Type 2 diabetes (T2D) medications such as Metformin, Dr. Lonier added, have been studied as adjunctive therapies for T1D patients as well but, “unfortunately, none of the non-insulin therapies thus far have a significant impact on blood glucose control in T1D,” she said. 

It’s always possible that something effective will be developed or discovered in the future of adjunctive treatments, “But right now the most immediately promising developments are related to improvements in pump and sensor technology.”