GLP-1 Receptor Agonists and SGLT-2 Inhibitors as Adjuncts to Insulin in Type 1 Diabetes: Benefits and Concerns.

The metabolic control of type 1 diabetes (T1D) is more difficult and complicated than type 2 diabetes (T2D). Although novel basal and prandial insulin analogues and systems for continuous glucose monitoring connected to smart insulin pumps/pens are now available, more than 70% of individuals with T1D do not meet the recommended glucose targets. Intensification of treatment with insulin is associated with an increased risk of hypoglycemia and weight gain. Furthermore, in T1D, there is an increasing prevalence of obesity, dyslipidemia, depression, and other risk factors for cardiovascular disease (CVD). The paracrine regulation of glucagon secretion by insulin in the islet environment is also lost in T1D leading to hyperglucagonemia. Together with these drawbacks, insulin resistance (IR) is present from the early stages of the disease contributing substantially to metabolic dysregulation and β-cell loss (1). The treatment of T1D is therefore staggering, and the way to tackle this is by assigning therapeutic strategies that include targets not only within but also beyond glycemic control.