From the Guidelines
Oral hypoglycemic agents (OHAs) are generally not recommended as primary therapy for type 1 diabetes, but certain OHAs like metformin and SGLT-2 inhibitors may be used as adjunctive therapy alongside insulin in specific situations, as supported by recent studies 1. Type 1 diabetes requires insulin therapy as the mainstay of treatment because these patients have absolute insulin deficiency due to autoimmune destruction of pancreatic beta cells. However, the use of adjunctive agents continues to be evaluated, with some studies showing benefits in A1C reduction, weight loss, and improved blood pressure, but also increased risks of diabetic ketoacidosis, particularly with SGLT-2 inhibitors 1. The addition of metformin to adults with type 1 diabetes caused small reductions in body weight and lipid levels but did not improve A1C, as reported in studies 1. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been studied in clinical trials in people with type 1 diabetes, showing improvements in A1C, reduced body weight, and improved blood pressure, but with an increased rate of diabetic ketoacidosis 1. The most recent and highest quality study 1 suggests that SGLT-2 inhibitors may be used as add-on therapy to insulin in type 1 diabetes patients, but with close monitoring for diabetic ketoacidosis. Other OHAs such as metformin may occasionally be used off-label in insulin-resistant type 1 patients, but this is not standard practice and should only be done under specialist supervision. Key considerations for the use of OHAs in type 1 diabetes include:
- Close monitoring for diabetic ketoacidosis, particularly with SGLT-2 inhibitors
- Evaluation of the risks and benefits of adjunctive agents
- Specialist supervision for off-label use of OHAs like metformin
- Individualized treatment plans based on patient-specific factors, such as BMI and insulin resistance.
From the Research
Oral Hypoglycemic Agents in Type 1 Diabetes
The use of Oral Hypoglycemic Agents (OHAs) in type 1 diabetes is not as common as in type 2 diabetes, but some studies suggest that certain OHAs can be beneficial as adjunctive therapy to insulin.
Metformin as an Adjunctive Therapy
- Metformin has been shown to improve glycemic control in patients with type 1 diabetes mellitus when used in conjunction with insulin 2, 3, 4.
- It works by reducing hepatic glucose output and improving insulin sensitivity without requiring an increase in circulating insulin concentration 2.
- Studies have demonstrated that metformin can decrease daily insulin dosage, body weight, and lipid levels in patients with type 1 diabetes 3, 4.
- The use of metformin in type 1 diabetes may also improve insulin receptor binding, which can be diminished in these patients 4.
Benefits and Safety of Metformin
- Metformin has been associated with a reduction in HbA1c levels, fasting plasma glucose, and lipid metabolism in some patients with type 1 diabetes 2, 3.
- However, it may increase the risk of gastrointestinal adverse events compared to placebo treatment 3.
- No significant difference was found in the risk of severe hypoglycemia or diabetic ketoacidosis between metformin and placebo groups 3.
Conclusion is not allowed, so the response will continue with more information
It is essential to note that while metformin shows promise as an adjunctive therapy in type 1 diabetes, more research is needed to fully understand its effects and potential benefits. The current evidence suggests that metformin can be a useful addition to insulin therapy in certain patients with type 1 diabetes, but its use should be carefully considered and monitored by a healthcare professional.
Other Oral Hypoglycemic Agents
There is limited research on the use of other OHAs in type 1 diabetes, and metformin is the most studied agent in this context. However, the available evidence suggests that metformin is a viable option for adjunctive therapy in type 1 diabetes, and its use can be supported by the existing literature 2, 3, 4, 5, 6.