Potential role of non-insulin adjunct therapy in Type 1 diabetes

    Research output: Contribution to journalArticle

    29 Citations (Scopus)

    Abstract

    Despite improvements in the pharmacodynamics of injectable insulin and better insulin delivery systems, glucose control remains suboptimal in the majority of individuals with Type 1 diabetes. Profound defects in the physiological processes that normally maintain glucose homeostasis contribute to the difficulty in achieving glycaemic targets. Non-insulin-based adjunct treatments offer a potential means of complementing intensive insulin therapy in Type 1 diabetes through addressing some of the physiological disturbances that result from endogenous ß-cell destruction, particularly through preservation of ß-cell mass and prevention of apoptosis, and suppression of a-cell glucagon release in the postprandial state. The former approach applies most readily to newly diagnosed C-peptide-positive Type 1 diabetes, while the latter to established C-peptide-negative Type 1 diabetes. This review focuses primarily on the clinical trial data available on the use of non-insulin-based therapies in longer-duration Type 1 diabetes. We conclude that metformin may prove useful in macrovascular disease reduction, while pramlintide, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors and leptin co-therapies may reduce HbA(1c) , glucose variability, postprandial glucose excursions and body weight. These early studies are encouraging and offer novel and potentially very effective approaches to the treatment of Type 1 diabetes, but the evidence is largely restricted to small, often uncontrolled trials. As such, these therapies cannot be currently recommended for routine clinical practice. There is a clear need to support large, multi-centre randomized controlled trials designed to establish whether adjunct insulin therapy has a place in the modern management of Type 1 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
    Original languageEnglish
    Pages (from-to)179-188
    Number of pages10
    JournalDiabetic Medicine
    Volume30
    Issue number2
    DOIs
    Publication statusPublished - 1 Feb 2013

    Fingerprint

    Type 1 Diabetes Mellitus
    Insulin
    Glucose
    C-Peptide
    Therapeutics
    Dipeptidyl-Peptidase IV Inhibitors
    Physiological Phenomena
    Glucagon-Like Peptide 1
    Metformin
    Leptin
    Glucagon
    Homeostasis
    Randomized Controlled Trials
    Body Weight
    Medicine
    Clinical Trials
    Apoptosis
    Injections

    Cite this

    @article{ac1ce36d773b44f5aadf1ec0abec14d5,
    title = "Potential role of non-insulin adjunct therapy in Type 1 diabetes",
    abstract = "Despite improvements in the pharmacodynamics of injectable insulin and better insulin delivery systems, glucose control remains suboptimal in the majority of individuals with Type 1 diabetes. Profound defects in the physiological processes that normally maintain glucose homeostasis contribute to the difficulty in achieving glycaemic targets. Non-insulin-based adjunct treatments offer a potential means of complementing intensive insulin therapy in Type 1 diabetes through addressing some of the physiological disturbances that result from endogenous {\ss}-cell destruction, particularly through preservation of {\ss}-cell mass and prevention of apoptosis, and suppression of a-cell glucagon release in the postprandial state. The former approach applies most readily to newly diagnosed C-peptide-positive Type 1 diabetes, while the latter to established C-peptide-negative Type 1 diabetes. This review focuses primarily on the clinical trial data available on the use of non-insulin-based therapies in longer-duration Type 1 diabetes. We conclude that metformin may prove useful in macrovascular disease reduction, while pramlintide, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors and leptin co-therapies may reduce HbA(1c) , glucose variability, postprandial glucose excursions and body weight. These early studies are encouraging and offer novel and potentially very effective approaches to the treatment of Type 1 diabetes, but the evidence is largely restricted to small, often uncontrolled trials. As such, these therapies cannot be currently recommended for routine clinical practice. There is a clear need to support large, multi-centre randomized controlled trials designed to establish whether adjunct insulin therapy has a place in the modern management of Type 1 diabetes. {\circledC} 2012 The Authors. Diabetic Medicine {\circledC} 2012 Diabetes UK.",
    author = "P. George and McCrimmon, {R J}",
    note = "Copyright 2013 Elsevier B.V., All rights reserved.",
    year = "2013",
    month = "2",
    day = "1",
    doi = "10.1111/j.1464-5491.2012.03744.x",
    language = "English",
    volume = "30",
    pages = "179--188",
    journal = "Diabetic Medicine",
    issn = "0742-3071",
    publisher = "Wiley",
    number = "2",

    }

    Potential role of non-insulin adjunct therapy in Type 1 diabetes. / George, P.; McCrimmon, R J.

    In: Diabetic Medicine, Vol. 30, No. 2, 01.02.2013, p. 179-188.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Potential role of non-insulin adjunct therapy in Type 1 diabetes

    AU - George, P.

    AU - McCrimmon, R J

    N1 - Copyright 2013 Elsevier B.V., All rights reserved.

    PY - 2013/2/1

    Y1 - 2013/2/1

    N2 - Despite improvements in the pharmacodynamics of injectable insulin and better insulin delivery systems, glucose control remains suboptimal in the majority of individuals with Type 1 diabetes. Profound defects in the physiological processes that normally maintain glucose homeostasis contribute to the difficulty in achieving glycaemic targets. Non-insulin-based adjunct treatments offer a potential means of complementing intensive insulin therapy in Type 1 diabetes through addressing some of the physiological disturbances that result from endogenous ß-cell destruction, particularly through preservation of ß-cell mass and prevention of apoptosis, and suppression of a-cell glucagon release in the postprandial state. The former approach applies most readily to newly diagnosed C-peptide-positive Type 1 diabetes, while the latter to established C-peptide-negative Type 1 diabetes. This review focuses primarily on the clinical trial data available on the use of non-insulin-based therapies in longer-duration Type 1 diabetes. We conclude that metformin may prove useful in macrovascular disease reduction, while pramlintide, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors and leptin co-therapies may reduce HbA(1c) , glucose variability, postprandial glucose excursions and body weight. These early studies are encouraging and offer novel and potentially very effective approaches to the treatment of Type 1 diabetes, but the evidence is largely restricted to small, often uncontrolled trials. As such, these therapies cannot be currently recommended for routine clinical practice. There is a clear need to support large, multi-centre randomized controlled trials designed to establish whether adjunct insulin therapy has a place in the modern management of Type 1 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

    AB - Despite improvements in the pharmacodynamics of injectable insulin and better insulin delivery systems, glucose control remains suboptimal in the majority of individuals with Type 1 diabetes. Profound defects in the physiological processes that normally maintain glucose homeostasis contribute to the difficulty in achieving glycaemic targets. Non-insulin-based adjunct treatments offer a potential means of complementing intensive insulin therapy in Type 1 diabetes through addressing some of the physiological disturbances that result from endogenous ß-cell destruction, particularly through preservation of ß-cell mass and prevention of apoptosis, and suppression of a-cell glucagon release in the postprandial state. The former approach applies most readily to newly diagnosed C-peptide-positive Type 1 diabetes, while the latter to established C-peptide-negative Type 1 diabetes. This review focuses primarily on the clinical trial data available on the use of non-insulin-based therapies in longer-duration Type 1 diabetes. We conclude that metformin may prove useful in macrovascular disease reduction, while pramlintide, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors and leptin co-therapies may reduce HbA(1c) , glucose variability, postprandial glucose excursions and body weight. These early studies are encouraging and offer novel and potentially very effective approaches to the treatment of Type 1 diabetes, but the evidence is largely restricted to small, often uncontrolled trials. As such, these therapies cannot be currently recommended for routine clinical practice. There is a clear need to support large, multi-centre randomized controlled trials designed to establish whether adjunct insulin therapy has a place in the modern management of Type 1 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

    UR - http://www.scopus.com/inward/record.url?scp=84872714268&partnerID=8YFLogxK

    U2 - 10.1111/j.1464-5491.2012.03744.x

    DO - 10.1111/j.1464-5491.2012.03744.x

    M3 - Article

    VL - 30

    SP - 179

    EP - 188

    JO - Diabetic Medicine

    JF - Diabetic Medicine

    SN - 0742-3071

    IS - 2

    ER -