Adjunct Therapies in Type 1 Diabetes

To date there are no licensed therapies for Type 1 diabetes except insulin in Canada. Recently the European Medicines Agency has given approval for Dapaglifozin in T1D, while the FDA rejected Sotagliflozin. Trials of these agents in Type 1 have shown modest reductions in HbA1c, weight and insulin use, with an increase in Time in Range. These benefits were at the expense of a increase in risk of DKA-despite the clinical trial setting - where oversight is much stricter than in routine clinical practice.  Safe use of these agents in type 1 will require substantial education for prescribers and most importantly, patients. Helping people think about taking insulin to treat elevated ketone levels and not just if blood glucose levels are high is a major paradigm shift. Enabling safe use seems a more patient focused approach than prohibiting access to therapies which may have significant benefits for sane individuals with type one diabetes. The potential benefit of combining these agents with artificial pancreas is currently being investigated in a Diabetes Action Canada study led by Dr. Bruce Perkins


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