Triple medicine approach could improve blood sugar control in type 1 diabetes

Overweight or obese people with type 1 diabetes who are treated with insulin, Victoza (liraglutide) and Forxiga (dapagliflozin) could have improved blood sugar control, according to new research.
Scientists from the University at Buffalo, New York, US also observed that patients treated with all three medications were able to lose more weight than patients who didn’t take dapagliflozin.
This new study involved 30 people with type 1 diabetes, aged between 18 and 75 years, who were already taking liraglutide and insulin together for at least six months. Liraglutide is a GLP11 analogue that works by stimulating the secretion insulin and lowering blood sugar levels.
A research team led by Dr Paresh Dandona wanted to investigate if dapagliflozi, an SGLT2 inhibitor, could help improve the patients’ blood sugar levels further, writing that “a majority of patients who have type 1 diabetes do not have their blood glucose levels sufficiently controlled and monitored, and then they are left vulnerable to more complications of the disease”.
Patients were randomised to receive either 10mg of dapagliflozin or placebo on top of their medication regimen. Dapagliflozin helps reduce blood glucose levels by removing glucose through urine.
The study period lasted 12 weeks, and participants used continuous glucose monitors (CGMs) to monitor their blood sugar levels. The researchers also evaluated the participants’ weight.
At the start of the study, the dapagliflozin group had an average body weight of 85kg compared to 79kg in the placebo group. HbA1c levels at the start of the study were 62 mmol/mol (7.8%) in the dapagliflozin group and 57 mmol/mol (7.4%) in the placebo group.
Overall, HbA1c fell by 7.3 mmol/mol (0.66%) among patients taking all three medications, but no significant change was observed in the placebo group. Body weight fell by 1.9kg in the dapagliflozin group compared to a 0.7kg reduction in the placebo group.
“Our research found a triple therapy (insulin, liraglutide and dapagliflozin) approach led to impressive improvements in blood glucose control as well as weight loss. This strategy advances our previous work showing improvements in blood glucose management with the use of liraglutide in combination with insulin,” said senior author Dr Paresh Dandona.
Dandona’s team noted that all patients taking dapagliflozin had increased ketones, which could predispose them to developing diabetic ketoacidosis (DKA).
This predisposition could occur “particularly among those who have a marked reduction in insulin from taking liraglutide together with dapagliflozin and who have consumed too few carbohydrates.”
They acknowledged that further research is needed and on the basis of the data, insulin doses might need to be reduced, while higher doses of dapagliflozin should be avoided.
“If it is decided to use this approach, then it must be used only by a knowledgeable patient along with an endocrinologist who is well versed with it,” concluded the authors.
The findings appear in the Endocrine Society’s Journal of Clinical Endocrinology and Metabolism.