June 22-26, 2018 marked the American Diabetes Association’s 78th Scientific Sessions, taking place in Orlando Florida. Each year, the ADA conference brings together scientists, researchers, endos, clinicians, the diabetes industry and advocates to share in learning from the best of the best. Through 3000 original research presentations over 5 days, there’s a lot to absorb. We were there to learn all we could about the latest in Type 1 diabetes.
We wanted to take some time to share the things that we think you, the Type 1 community, should keep your eyes on, things we found interesting, and things that created buzz. Watch for updates in the coming days outlining the latest in drugs, devices, and education in this 4-part series.
SOTAGLIFLOZIN AND TYPE 1 DIABETES: ZYNQUISTA
These drugs are once-daily pills. What these drugs do are block the proteins that cause excess glucose to be reabsorbed. Think of it like this: Our bodies do not want to waste energy. From an evolutionary perspective, we were built to retain energy in case we need it for an emergency later. Our bodies have proteins (SGLT1 and SGLT2) that allow us to reabsorb energy that would otherwise be wasted. SGLT1 proteins are in our guts. SGLT2 proteins are in our kidneys. These drugs work to block these proteins from working. This leads to less reabsorbed glucose and less glucose floating around in our blood, potentially decreased insulin requirements, decreasing post-meal BG spikes, and initiating weight loss.
At ADA we learned about the results of the InTandem1 study that reported the outcomes of 1-year of sotagliflozin use. The study analyzed the change in average BG and body weight and assessed safety. It found that after 1-year of use, adults with Type 1 experienced decreased A1Cs, weight loss, and decreased insulin requirements.
SHOW US THE SCIENCE:
793 adults with Type 1 diabetes participated in this study and were placed randomly in one of three study groups:
- 200mg daily sotagliflozin
- 400mg daily sotagliflozin
The following outcomes were seen:
- decreased A1C (200mg – .25 / 400mg – .31),
- decreased weight (200mg – 3.1kg lost / 400mg – 4.3kg lost),
- decreased bolus insulin (200mg – 1.4% decrease / 400mg 8.6% decrease).
- Some participants did experience DKA – one of the major risks of this kind of drug therapy (placebo – 1 episode / 200mg – 9 episodes / 400mg – 11 episodes)
As we see more adjunct (in addition to insulin) therapies becoming available to people with Type 1, we think this is one to keep an eye on. This drug is currently under review by the FDA for an indication for Type 1s.
GLP1s AND TYPE 1 DIABETES
These drugs are injectables. You’d use them anywhere from once per day to once per week depending on which one you’re using. The main function of these drugs are to:
- delay gastric emptying;
- decrease liver glucose production;
- increase insulin secretion. (Of course, if you’re living with Type 1, you can scratch #3 off of your list of benefits – we’re not making insulin anyway!)
In simple terms, you could feel fuller for longer, and may not get as significant BG spikes caused by your liver creating glucose in times between eating. On a very practical level, you could expect to eat less and have better BGs both before and after meals.
Presented at ADA, research shows that after a 1-year trial, adults with Type 1 diabetes using a GLP1 injectable (Victoza) experienced lower A1C, more time in range, decreased blood pressure and increased weight loss than those not using the drug.
SHOW US THE SCIENCE:
- 46 adults with Type 1 diabetes participated in this double-blinded, placebo-controlled, randomized study.
- 26 adults were placed in the GLP1 group.
- 20 were in the placebo group.
- The GLP group saw a decreased A1C of .4% on average, an average of 3kg of weight lost, and blood pressure decreasing from 128/79 to 122/75mmHg. No significant change in low BGs were reported.
We’re getting closer to this class of drugs being indicated for Type 1 diabetes! Currently, they are only prescribed to adults with Type 2 diabetes, or used off-label (meaning, technically not allowed to be used but people are resourceful…) This study could help us get closer to adding another option to our tool-kit for our diabetes care.
In Part 2 and 3 of this series, we’ll share highlights from the latest in diabetes devices. Next post will include updates on the Dual-Hormone Artificial Pancreas, Closed-Loop versus Open-Loop Devices, and will provide a product highlight on the research around the new Omnipod Horizon Hybrid Closed-Loop System. Stay tuned!
Disclaimer: Please check out CIM’s Partners Page to learn more about the companies we work with. This post was not paid for and does not represent sponsored content, but it’s important to recognize that we may be biased based on the fact that some companies highlighted below support CIM in different ways. We still thought this info was important for you to know about.