Novel blood glucose lowering therapies for managing type 1 diabetes in paediatric patients

ABSTRACT

Introduction: Therapy for type 1 diabetes (T1D) is mainly restricted to insulin treatment. The management of paediatric patients with T1D should tackle not only glucose control, but also insulin resistance, beta-cell preservation, quality of life and cardiovascular disease risk factors, which are increasingly recognized to occur in adolescents with T1D.

Areas covered: This review examines the recently published literature from PubMed on non-insulin agents for the management of T1D in paediatric patients.

Expert opinion: Few paediatric patients with T1D are achieving their metabolic targets. Current data support the need for new strategies and the consideration of additional therapies that not only may help patients, their families and their physicians to meet HbA1c targets, but also may preserve residual islet mass and good quality of life and prevent microvascular and macrovascular complications, thereby, reducing hypoglycaemic episodes. Non-insulin adjunctive therapies may improve not only glucose control, but also insulin sensitivity, in addition to preserving beta-cell function in T1D patients. Thus, more studies are required to define the potential role of these therapies in the management of paediatric patients.

KEYWORDS:

• Paediatric patients
• adolescents
• children
• insulin
• type 1 diabetes
• beta cell function
• metformin
• GLP-1 receptor agonists
• SGLT-2 inhibitors
• DPP-4 inhibitors

Declaration of interest

P Pozzilli has received research grants from Lexicon, AstraZeneca, Eli Lilly and Company, Sanofi, Merck Sharp and Dohme as well as honoraria from Eli Lilly, Sanofi and GlaxoSmithKline. 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. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Article highlights

• T1D is the most common chronic childhood metabolic disease and characterized by destruction of pancreatic beta-cells following immune processes, leading to chronic insulin deficiency and therefore hyperglycemia.

• Actually, insulin remains the gold standard therapy in pediatric patients despite most of the young T1D patients having suboptimal glucose control, and consequently, using adjunctive non-insulin pharmacotherapy to improve metabolic control has been of clinical interest.

• Blood glucose lowering therapies such as metformin, GLP-1 receptor agonists, DPP-4 inhibitors or SGLT-2 inhibitors, as adjunctive treatments with insulin, may improve the management of pediatric patients with T1D.

• Non-insulin adjunctive therapies may improve not only glucose control, but also insulin sensitivity and could offer benefits in the preservation of beta-cell function, whose importance has been well-demonstrated.

• Still, larger trials with longer follow-up are needed to evaluate the impact on glycemic control, the long-term benefits with respect to microvascular and macrovascular complications, and the safety profile of these adjunctive therapies in the management of pediatric patients with T1D.

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Additional information

Funding

The authors acknowledge funding in the form of grants received by University Campus Bio-Medico of Rome including funding for clinical trials using GLP-1 receptor agonists, SGLT-2 inhibitors and insulin.