Pharmacologic treatment options for type 1 diabetes: what’s new?

ABSTRACT

Introduction: The expanding variety of insulins, including biosynthetic human insulin and rapid and long-acting insulin analogs, have dramatically transformed the management of type 1 diabetes (T1D) over the past 25 years. Moreover, increasing interest in the use of novel drugs developed for the treatment of type 2 diabetes (T2D) as adjunctive therapies for T1D remains a work in progress.

Areas Covered: We reviewed articles published up to December 2018 in PubMed and ClinicalTrials.gov for recent developments in the pharmacologic treatment of T1D, including inhaled insulin, ultrafast and ultralong-acting insulins and adjunctive therapies including pramlintide, metformin, GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2, and SGLT1/2 inhibitors.

Expert Opinion: With the creation of ultrafast-acting insulin analogs and very prolonged duration of action of basal insulins, it is possible to more closely mimic physiologic insulin secretion. Adjunctive therapies, likewise, may also overcome some of the abnormal physiology that is a hallmark of T1D. Therefore, individualized consideration of the efficacy of these agents must be measured alongside the potential adverse effects when choosing an adjunctive therapy.

KEYWORDS:

• Type 1 diabetes
• insulin
• analogue
• adjunctive therapy
• inhaled insulin
• ultrafast insulin
• GLP-1 receptor agonists
• SGLT-2
• pramlintide

Article highlights

• The management of T1D has transformed dramatically over the past century from having only 1 type of insulin that was derived from animals to making human insulin using recombinant DNA technology.

• Due to the need for a faster, more potent onset of action, ultrafast insulin analogues and inhaled insulins have been clinically used for T1D to prevent postprandial hyperglycemia and mimic physiologic insulin secretion.

• Likewise, ultralong basal insulin analogues were developed to more closely match physiologic insulin secretion and create a flatter pharmacodynamic profile without a substantial action peak.

• Multiple therapies have been developed for the treatment of T2D, and studies to evaluate the potential clinical benefits those T1D are reviewed here.

Declaration of interest

WV Tamborlane is a consultant for Boehringer Ingelheim, Eli Lilly, Medtronic Diabetes, Novo Nordisk and has received grants support from AstraZeneca, Boehringer Ingelheim and Takeda. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed being on the Advisory Board for Lilly, NovoNordisk, Intarcia. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was supported by the National Institutes of Health under award number K12 DK094714.