Below is the content from an email I received from JDRF. I am sharing this information on my blog so it’s widely available for anyone intrigued by the topic.
While I do not fall into the obese category, I have been using adjunct therapies, such as insulin and ozempic for the better part of 5 years. It has made my blood sugar control less hard (I can’t put diabetes and easy in the same sentence!) but using ozempic can be tricky, causing me more lows at times, and lows that drop harshly.
If you have any questions about using ozempic as someone with type 1 diabetes, please feel free to reach out. I was also interviewed on a podcast with 2 other T1s on this topic and you can listen to the episode by clicking below.
Now, onto the informal email on adjunct therapies…
Hi there,
For diabetes, adjunct therapies, in addition to insulin, help to potentially lower your blood-sugar levels, while at the same time reducing the risk of low blood-sugar events and having a beneficial effect on body weight. Some of them also can lower your risk of major cardiovascular events, such as heart attack and stroke, preserve kidney health, and be used to treat obesity.
Metformin, GLP-1 treatments, and SGLT inhibitors are all approved for use in type 2 diabetes (T2D). None of them are approved for people with type 1 diabetes (T1D).
We hope to change that.
Let’s look at these adjunct therapies and how they may one day help people with T1D.
Metformin: Metformin is the first-line drug in the therapy for T2D and was approved by the Food & Drug Administration (FDA) in 1994. It stops your liver from making too much sugar and helps the sugar get into your cells. JDRF funded a clinical trial that demonstrated that adding metformin, in addition to insulin, improved blood-sugar control, reduced the need for insulin, and promoted the reduction and maintenance of normal body weight.
GLP-1 Treatments: GLP-1, which stands for glucagon-like peptide-1, drugs lower blood-sugar levels and, for most people, cause weight loss. GLP-1 therapies have also been shown to reduce the risk of long-term cardiovascular complications such as heart attack and stroke. In 2005, the FDA approved Byetta® (exenatide). Seven GLP-1 medicines are on the market or have been on the market, including Ozempic®/Rybelsus®/Wegovy® (semaglutide).1
SGLT Inhibitors: SGLT, which stands for sodium-glucose co-transporter, inhibitors lower blood sugar by preventing the kidneys from reabsorbing glucose, leading to the excretion of sugar through the urine. These drugs also provide benefits such as weight loss, blood pressure reduction, and benefits to the heart and kidneys. The FDA approved the first SGLT inhibitor in 2013. There are five SGLT inhibitors on the market today.2
Why Aren’t They Approved for T1D?
JDRF and others have funded multiple clinical trials to test T1D adjunct therapies—such as metformin, GLP-1 treatments, and SGLT inhibitors—and, despite demonstrating improved glucose control, the FDA has not approved these treatments for people with T1D.
With GLP-1 treatments, although they reduced HbA1c and total insulin dose, they increased the rates of low blood sugar (called hypoglycemia) and high blood sugar (hyperglycemia) events, thereby limiting its clinical use. These trials, however, were done with older GLP-1 drugs. Whether the newest, most advanced GLP-1 therapies will improve T1D health is an open question that JDRF is investigating.
With SGLT inhibitors, it is due, in part, to an increased risk of diabetic ketoacidosis (DKA).
JDRF’s Commitment to Improving Lives
Insulin therapy alone is often not enough for people with T1D to achieve blood sugar control; the use of adjunct drugs that complement insulin therapy can help. There are several ways that JDRF is making headway toward adjunct therapies being approved and used for T1D:
GLP-1 Therapy: JDRF is taking all the shots on goal to understand the benefits of glucose management and treatment of heart and kidney complications. Viral Shah, M.D., is conducting a trial to study semaglutide as an adjunct therapy to hybrid closed loop systems for obese people with T1D. The trial aims to understand the potential blood-sugar and heart benefits for this population that is at increased risk of heart disease.
Continuous Ketone Monitors: The development of continuous glucose monitors plus continuous ketone monitors (CGM-CKM), which can warn users of approaching DKA and provide mitigation strategies to avoid it (such as administration of insulin and intake of carbohydrates), may enable safe, effective use of SGLT inhibitors in people with T1D. JDRF has given more than $3 million to drive the development of CGM-CKM devices to reduce DKA risk in people with T1D.
Glukokinase Therapy: vTv Therapeutics partnered with JDRF in 2017 to run a phase II clinical trial of cadisegliatin (TTP399), an adjunct glucokinase activator, in people with T1D. Cadisegliatin significantly improved HbA1c , as well as demonstrated a reduction in insulin dose, reduced low blood sugar, and no increase in DKA. Now, vTv has an investment from the JDRF T1D Fund to run a phase III clinical trial.
Ultimately, the goal of any JDRF support is to benefit the lives of people with T1D, and we couldn’t have accomplished this without you. Thank you for joining our vision, as we work toward ways to treat, prevent, and, ultimately, find cures for T1D.
Thanks again for all you do,
Your team at JDRF
