From the Guidelines
The use of GLP-1 receptor agonists, such as liraglutide, as an adjunct to insulin therapy in type 1 diabetes, is a viable option for improving glycemic control, reducing weight, and decreasing insulin doses, as demonstrated in recent clinical trials 1. When considering the management of type 1 diabetes, it is essential to prioritize treatments that minimize morbidity, mortality, and improve quality of life.
- GLP-1 receptor agonists have shown promise in clinical trials, with liraglutide 1.8 mg daily resulting in modest A1C reductions (0.4%), decreases in weight (5 kg), and reductions in insulin doses 1.
- The addition of these agents to insulin therapy can complement the existing treatment regimen by enhancing glucose-dependent insulin secretion, slowing gastric emptying, suppressing glucagon, and reducing appetite.
- However, it is crucial to note that GLP-1 receptor agonists are not a replacement for insulin therapy in type 1 diabetes, as most patients have minimal beta cell function.
- Patients should work closely with their endocrinologist to determine appropriate dosing and make necessary insulin adjustments, as these medications may require adjustments to prevent severe hypoglycemia and mask hypoglycemia symptoms.
- Regular monitoring of blood glucose levels is essential when adding these medications to insulin regimens, and the benefits and risks of adjunctive agents should be carefully evaluated, with consideration of consensus statements providing guidance on patient selection and precautions 1.
From the Research
GLP-1 and GIP for Type 1 Diabetes
- GLP-1 receptor agonists have been explored as a potential treatment for type 1 diabetes, with studies showing promising results 2, 3, 4.
- A proof-of-concept study found that liraglutide, a GLP-1 receptor agonist, reduced mean blood glucose and daily insulin requirement in patients with type 1 diabetes 2.
- A real-world study found that GLP-1 receptor agonists and SGLT2 inhibitors were associated with clinically relevant benefits, including reductions in weight, HbA1c, and total daily dose of insulin 3.
- The adjunctive role of GLP-1 receptor agonists in the management of type 1 diabetes has been evaluated, with studies showing significant reductions in hemoglobin A1C, plasma glucose concentration, body weight, and insulin doses 4.
Mechanisms of Action
- GLP-1 receptor agonists work by augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, decelerating gastric emptying, and reducing calorie intake and body weight 5.
- GLP-1 receptor agonists have been shown to improve glycemic control, reduce glucose excursions, and decrease hypoglycemia in patients with type 1 diabetes 2, 3, 4.
Safety and Efficacy
- The safety and efficacy of GLP-1 receptor agonists in patients with type 1 diabetes have been evaluated, with studies showing that they are generally well-tolerated and effective in improving glycemic control 2, 3, 4.
- However, the use of SGLT2 inhibitors in patients with type 1 diabetes has been associated with an increased risk of diabetic ketoacidosis 3.
Comparison to Traditional Insulin Therapy
- Traditional insulin therapy for type 1 diabetes has its limitations, including the risk of hypoglycemia and the need for frequent injections 6.
- GLP-1 receptor agonists may offer a useful adjunct to traditional insulin therapy, providing additional benefits in terms of glycemic control and weight loss 2, 3, 4.