Recent developments in adjunct therapies for type 1 diabetes.

INTRODUCTION: There have been many recent advances in the treatment of type 1 diabetes (T1D) including in insulin formulations, continuous glucose monitoring (CGM) technology and automated insulin delivery. However, long-term optimal glycaemic control is still only achieved in a minority.

AREAS COVERED: Adjunct therapy - the use of therapeutic agents other than insulin - is one strategy aimed at improving outcomes. An ideal adjunct agent would improve glycaemic control, reduce weight (or weight gain), reduce insulin requirement and prevent complications (e.g. cardiorenal) without increasing hypoglycaemia. The amylin analogue pramlintide, has been licensed in the USA, while the sodium glucose co-transporter-2 inhibitor (SGLT2i) dapagliflozin, was briefly (2019 -2021) licensed for type 1 diabetes in Europe and the UK. However, other agents from the type 2 diabetes (T2D) arena including metformin, other SGLT2is, glucagon-like peptide-1 receptor agonists (GLP1RA) and dipeptidyl peptidase-IV (DPP-4) inhibitors have been investigated.

EXPERT OPINION: As evidence emerges for cardiorenal protection by SGLT2i and GLP1RAs in T2D, it has become increasingly important to know whether people with T1D can also benefit. Here we review recent trials of adjunct agents in T1D and discuss the efficacy and safety of these agents (alone and in combination) in an era in which continuous glucose monitoring is becoming standard of care.