Adjunctive therapies are treatments that complement insulin to achieve glucose control and to help manage additional metabolic conditions experienced by people with T1D, including insulin resistance and obesity. Improved control of glucose and metabolism also plays an important role in slowing progression of long-term complications associated with T1D.
Pramlintide is a synthetic amylin analog administered via syringe. It is approved for people with T1D who use mealtime insulin and do not achieve their glycemic targets despite optimal insulin therapy. Pramlintide limits glucose fluctuations after meals. Pramlintide therapy can also lead to weight-loss and improvements in risk factors for cardiovascular disease.
Originally developed for the treatment of type 2 diabetes (T2D), metformin, administered via a pill, can be prescribed to people with T1D in addition to insulin therapy, diet, and exercise to help improve insulin sensitivity and reduce insulin dose requirements. People with insulin resistance, of higher weight, and at risk for cardiovascular disease may be more likely to experience metabolic benefits with metformin.
GLP-1 receptor agonists
Glucagon-like peptide-1 (GLP-1) receptor agonists are commonly used to treat T2D. Though not approved for T1D, GLP-1 agonists, administered both orally and through injections, have been shown to have glycemic and metabolic benefits in people with T1D. They can lead to reduced insulin needs, weight loss, and may reduce risk of cardiovascular disease.
Sodium-glucose co-transporter (SGLT) inhibitors lower blood sugar levels by preventing glucose reabsorption in the kidneys and increasing glucose excretion through the urine. In addition to glycemic control, SGLT inhibitors, which are taken orally, also have metabolic benefits in weight loss and improved cardiac and kidney function. These benefits have led to approval of SGLT inhibitors for T2D, chronic kidney disease, and heart failure. SGLT inhibitors are not approved for glycemic control in T1D due to the elevated risk of diabetic ketoacidosis (DKA). A key JDRF priority is to find ways to mitigate this risk so people with T1D can also take advantage of the SGLT cardiovascular and renal benefits.
Blood pressure and cholesterol medications
In T1D, hyperglycemia (high blood sugar) and poor glycemic control impact cardiovascular outcomes, including blood pressure and cholesterol levels. Long disease duration and increased risk of microvascular complications in T1D also contribute to the high prevalence of cardiovascular disease in T1D. Therapies such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), statins, and other lipid-lowering drugs may be prescribed to manage cardiovascular disease and reduce the risk of cardiovascular complications.
Editor’s note: How you manage your type 1 diabetes is a personal decision that should be made by you and your healthcare team. JDRF content is for informational purposes only and is not a substitute for professional medical advice. Please contact your doctor or other qualified health provider with any questions you may have regarding type 1 diabetes treatments or any medical condition.